CATS-NET LTD RESIDENTIAL CABLE INTERNET CONNECTION REQUEST FORM Please fill the form below with as much information as possible:
Date: ______________________ Contact Name: ________________________________________ Company Name: _______________________________________ Physical & Postal Address: _______________________________ _______________________________ _______________________________ Tel No: ___________________ (O) __________________ (R)
Mobile No: ______________________ Fax No: __________________ E-mail Address: __________________________________ Please indicate the following: 1) 2) a) b) c) d) 3) Do You have a Desktop or a Laptop? (D/L) What Operating System does it run on? Windows 95 Windows 98 Windows ME Windows NT e) f) g) h) Windows 2000 Windows XP Windows 2003 Mac OS: ________ Ver _______
Does your machine have a network card? (Y/N) If No, would you like us to sell you one? ______ (Y/N)
Payment Plan: 1) Which Subscription would suit you the best? (incl. VAT) Connection Fees: ($90) – one time only Monthly ($60) Quarterly ($174) Half-Yearly ($324) Yearly ($576) Payments have to be made Pro-Rata if subscription commences after the beginning of a month. Mode of Payment – (Cash / Cheque) – (To be made in Advance)
2) 3)
Note: A Site Survey will have to be made to find out whether a cable connection is feasible
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