Internet Service Request Form (SRF) .XLSX To Mr. Cletus
Internet Service Request Form (SRF) .XLSX To Mr. Cletus
Internet Service Request Form (SRF) .XLSX To Mr. Cletus
Customer Information
Note: the requestor details may have already been captured in the database. If so, it is not necessary to
REQUESTOR DETAILS complete these fields.
Company Name:
Billing/Postal Address:
RC Number:
Date of Incorporation:
VAT No.:
Vat Registration date:
Name of Contact person:
Job Title:
Mobile No.:
E-Mail Address
Department:
Sector
Prospect info.
Product type* Please select an option from the list
If specify Interface type* Please select an option from the list
Required bandwidth - downstream* Please select an option from the list
Required bandwidth - upstream* Please select an option from the list
Kindly specify bandwidth if not indicated above*
Block of live IP address required*
Kindly confirm that a LAN router is available at location* Please select an option from the list
Is BGP configuration required? * Please select an option from the list
Is there a need to advertise IP routing table? * Please select an option from the list
Network conditions/assumptions
Internet Service will be terminated at central server point where customer will be responsible for redistribution on their LAN network
A LAN router is required at customer's end for service termination