Internet Service Request Form (SRF) .XLSX To Mr. Cletus

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MTN SERVICE REQUEST FORM - Technical data- (Internet Service)

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

Kindly specify other key technical requirements not stated


above

Monthly charge (Naira)


Installation charge (Naira)
Required Service date (dd/mm/yyyy):
SERVICE LOCATION AND EQUIPMENT DETAILS

Technical Contact person:


Site Telephone:
Mobile No.:
Site Address:
State:
Existing mast? s
If yes enter height (in metres):
Type of power available:
Voltage:
Coordinates
Type of equipment at customer premises:
Type of application to run on equipment:
Equipment racks
Business Solution Required/other comments-Should include
customer business requirements, including service application
to be used on service etc.

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

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