|
|
|
Partner name |
Somerset Systems Ltd |
Tracking Code |
|
|
Order taken by |
|
Partner Reference |
|
|
Telephone Number |
01278 685298 |
Date |
|
|
Partner Email Address for Order confirmation |
19 Crancombe Lane, Woolavington, Somerset, TA7 8DZ |
|
Clients Email Address for Order Confirmation |
|
|
Customer order details |
| |
Please enter the customers telephone number which needs to
be upgraded to Broadband |
| |
Please include area code |
|
| |
Please enter the customers BT account number |
| |
This can be found in top left hand corner of the bill |
|
|
Product details |
| |
Which product does the customer wish to order- Please
enter Yes for product required |
| |
BT Broadband Basic |
|
|
| |
BT Broadband |
|
|
| |
Additional Equipment |
| |
Modem Pack |
|
|
Router Pack |
|
| |
Additional Filters |
|
|
| |
(Please specify amount required) |
| |
Preferred installation/Activation date |
|
|
Customer name and Installation details |
| |
First Name |
|
Last Name |
|
| |
Address 1 |
|
| |
Address 2 |
|
| |
Town |
|
| |
County |
|
|
|
Post Code |
|
| |
Customer main contact number |
|
| |
Customer Alternative contact No. |
|
|
Alternative Delivery Address |
| |
Please state company name and address if different to
customers installation name and address |
| |
Address 1 |
|
| |
Address 2 |
|
| |
Town |
|
| |
County |
|
|
|
Post Code |
|
|
Please confirm that the customer has accepted the BT Terms
and conditions and Privacy Policy for the service |
Yes |
|
No |
