Postal Code: City/State: Contact Person Details: Title: Mr. Mrs. Miss Name: Telephone Number: Mobile Number: Fax Number: E-mail: 2 BILLING AND PRICING DETAILS – Company Name: Correspondence Address: Postal Code: City/State: Contact Person Details: Mr. Mrs. Miss Name: Telephone Number Mobile Number: Fax Number: E-mail: Payment Term : Monthly In Advance Quarterly In Advance Yearly In Advance SLA : Rebate Term: Monthly In Advance Quarterly In Advance Yearly In Advance Pricing Details: 3 - SERVICE DESCRIPTION AND CONTRACT INFORMATION INSTALLATION ADDRESS SITE A INSTALLATION ADDRESS SITE B This is where applicable) This is (Check where applicable) New Location : New Location Existing FIBRECOMM Nodes: Existing FIBRECOMM Nodes: Company: Company: Address: Address: Postal City/State: Postal Code: Code: Is this an end-user premise? Yes No Is this an end-user premise? Yes No Is the customer premises Co-Located in a Is the customer premises Co-Located in a FIBRECOMM FIBRECOMM Node/PoP? Yes No Node/PoP? Yes No Requested RFS Date : Contract Period(s) : 4 TECHNICAL DETAILS – Initial Port and Bandwidth Profile : Port Speed : Bandwidth : Bandwidth Subscription :
Postal Code: City/State: Contact Person Details: Title: Mr. Mrs. Miss Name: Telephone Number: Mobile Number: Fax Number: E-mail: 2 – BILLING AND PRICING DETAILS Company Name: Correspondence Address: Postal Code: City/State: Contact Person Details: Mr. Mrs. Miss Name: Telephone Number Mobile Number: Fax Number: E-mail: Payment Term : Monthly In Advance Quarterly In Advance Yearly In Advance SLA : Rebate Term: Monthly In Advance Quarterly In Advance Yearly In Advance Pricing Details: 3 - SERVICE DESCRIPTION AND CONTRACT INFORMATION INSTALLATION ADDRESS SITE A This is where applicable) New Location : Existing FIBRECOMM Nodes: INSTALLATION ADDRESS SITE B This is (Check where applicable) New Location Existing FIBRECOMM Nodes: Company: Company: Address: Address: City/State: Postal Code: Postal Code: Is this an end-user premise? Yes No Is this an end-user premise? Yes No Is the customer premises Co-Located in a FIBRECOMM Node/PoP? Yes No Is the customer premises Co-Located in a FIBRECOMM Node/PoP? Yes No Requested RFS Date : Contract Period(s) : 4 – TECHNICAL DETAILS Initial Port and Bandwidth Profile : Port Speed : Bandwidth : Bandwidth Subscription :
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