1. Your Details
|
2. Your Address
|
3. Contact Details
|
Title:
|
* |
xDSL Number:
|
* |
Address:
|
* |
First Name:
|
* |
Daytime Tel.:
|
* |
Address:
|
|
Last Name:
|
* |
Evening Tel.:
|
* |
Address:
|
|
Email Address:
|
|
Fax Number:
|
|
Post Code:
|
* |
|
4. Current ISP
Information
|
Current ISP:
|
* |
Current Package:
(Use your current ISP's term.)
|
* |
CBUK Number:
(Ask your current ISP for this.)
|
* |
|
5. Preferred Migration
Date
|
Preferred Migration
Date:
(Allow 2 weeks minimum.)
|
*
|
|
6. Your Comments
|
7. VISP Domain
Name?
|
|
Your accuracy is
greatly
appreciated
* |
