Contract Mobile Phone by yty76486

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									                            WWW.DARRYNANECOMPUTING.COM
      3Contract “Mobile Phone by Post” Application Form

1)     Firstly…. Please complete this application form and then save it on you own computer.
2)     Next …... Please send an email to info@darrynanecomputing.com and attach the
       saved file and also attach your Photo ID and Proof of Address…which you should
       have earlier scanned and saved as “jpeg” files on your computer….making a total of 3
       attachments. You can also send, if preferred, all the documents in the regular post to:--
       Darrynane Computing / Communications, Darrynane Beg, Caherdaniel, Co. Kerry.

Note: “Mobile by Post” applications cannot be processed until payment is received / cleared.
      There are several ways to do this. See “Payments” at www.darrynanecomputing.com.
      ( No PayPal account ?… consider opening one…its easy and free at www.paypal.com )

 Mobile Phone Make and Model and Colour Required:-
 Do you wish to Port your existing number to 3Network ?
 Title: (Mr / Mrs / Ms etc.)
 First Name:
 Last Name:
 Date of Birth:
 Marital Status: (Marrd / Single / Divrd / Cohab / Sep / Wid)
 Mobile Phone Number:
 Home Phone Number (Landline ---incl. area code):
 Please supply your Email Address:

 Address: House Name / Apartment Block Name
 Address : House Number / Apt. Number / + Street Name
 Address: Village / Locality:
 Address: Town / City:
 Address: County:
 Residential Status: (Owner / Rented / Leased etc.)
 Resident From:     dd / mm / yyyy
 Employment Status: (Employed / Self-employ / Unempl)

 Do you wish postal invoicing monthly for payment: Y / N
 Note: Monthly postal invoicing incurs €5 charge per bill !!

 Do you wish “3” to set up Direct Debit Payment:     Y/N
 Will Bank accept monthly Direct Debit payment:      Y/N
 Have you authority to sanction Direct Debit set up: Y / N
 Length of Time with Bank: YY / MM
 Bank Name:
 Bank Sort Code:
 Account Name / Names:
 Account Number:

 Do you accept 3 Network “Terms and Conditions” Y / N
 Will you pay the refundable €50 security deposit ? Y / N
 State the Payment Method used to process this order:

Confirm that you are ordering a “3Contract Mobile Phone by Post”. Total Cost =            Y/N
*Note: If no Security Deposit is requested after Credit Check then €50 is refunded by return.
(If a Security Deposit is requested then it will be returned by “3” after 6 months has elapsed)

								
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