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Service Job Order Form - Excel

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Service Job Order Form - Excel Powered By Docstoc
					 AdEPT Telecom
 77 Mount Ephraim
 Tunbridge Wells
 Kent                                                          Data Services Order Form
 TN4 8BS

 Tel 01892 550 200
 Fax 01892 550 201


ORDER DETAILS

                                 Point to Point leased line               MPLS                                            DSL


                                 Point to Point Ethernet                  Internet service

COMPANY DETAILS
                         Title                      First Name                                 Surname
Full Contact Name

Job Title

Company Name

Registered
Address


Postcode                                                                  Company reg. No.

Telephone                                                                                Fax

BILLING, PAYMENT AND TARIFF DETAILS
Billing address


                                                                                               Postcode

Telephone                                                                                Fax

                         Title                      First Name                                 Surname
Billing Contact                                                   Accounts Payable

Payment Method                            Direct Debit                    Cheque                         Automatic bank transfer

IF PAYING BY DIRECT DEBIT PLEASE ASK FOR DIRECT DEBIT MANDATE


Contract period                   3       Years

Service Payment                                                                                              Quarterly             Annually


Install charge       £                                     .                            Purchase order Number

Annual Rental        £                                     .

All charges are subject to site survey and may vary depending on service availability

SERVICE REQUIREMENTS
For Internet please specify bandwidth requirements
         256k                       512k                                  1MB                                2MB                         10MB

            20MB                          34MB                            100MB                              1GB                              other

bearer size                                                                                    10MB bearer


Installation address A end
Address
Postcode                                                    Telephone

Name of Site Contact

DDI or Mobile                                                      Fax

Email Address

PLEASE INDICATE THE EXACT LOCATION WHERE THE SERVICE WILL TERMINATE

Floor

Room

Position/Rack No.

    Is there spare power at site?                     Yes                No
    If No, when will power be made available?

				
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