Business IT Services

Broadband application form

For your complete Broadband service please complete the form below with your requirements and press the SUBMIT button. Any errors on the page can be cleared by pressing the RESET button. You will be contacted for further customer details.

Customer order details
1) Does the customer have a BT line?	Yes	No

2) What type of BT line does the customer have?	Standard (phone)	ISDN2/Business/Home Highway

3) Is the customer an existing BT Customer	Yes	No
(If Yes enter existing email address)



Existing BT password :

Telephone number for ADSL Connection :

Highway Conversion 2nd Number to be kept (PSTN CRF required) :

Product details

1) Which product does the customer wish to order- Please enter Yes for product required

Home connections - all free activation and free modem

Option 1: £9.95 (inc VAT) for first 6 months, £17.99 thereafter (8MB - 2gb allowance)
FREE 220V wired router
Wireless BT Home Hub for only £30
Home Hub Phone option for £49.99

Option 2 : £14.99 (inc VAT) for first 3 months, £22.99 thereafter (8MB - 6gb allowance)
FREE wireless BT Home Hub
Home Hub Phone option for £49.99

Option 3: £22.99 (inc VAT) for first 3 months, £26.99 thereafter (8MB - 40gb allowance)
FREE wireless BT Home Hub & Phone
FREE Home Hub Phone option

Static IP is Not available on Home Products.

Business connections - all free activation

BT £19.99 (excl VAT) Office Broadband up to 8MB - 10gb allowance
USB/Ethernet router @ £49
Wireless Router inc built in firewall @ £79

BT £29.99 (excl VAT) Office Broadband up to 8MB + FREE WIRELESS ROUTER - unlimited (single PC)
Option for 2 year contract (changing price to £26.99 per month)

BT £65.00 (excl VAT) Office Broadband up to 8MB + FREE WIRELESS ROUTER - unlimited (network)
Option for 2 year contract (changing price to £58.50 per month)
Static IP required £5 per month (Office connections only)

NOTES:- Please note that where a line does not support the 2Mbps speed, 1Mbps and/or 512kbs speeds will be offered. All Internet services are charged on the customer's BT bill at the end of the month. The customer will need to update their payment details with BT to set-up a Direct Debit form and qualify for any respective discounts. On capped services, charges are £4 extra (ex VAT) for 1-3 Gb extra usage, £8 extra (ex VAT) for 4-6 Gb extra usage, £12 extra (ex VAT) for over 6Gb extra usage

2) Preferred installation/Activation date (dd/mm/yyyy)

3) Preferred installation Time	AM	PM

Customer name and Installation details

First Name :
Last Name :
Company Name :
Address 1 :
Address 2 :
Town :
Country :
Post Code :
Customer main contact number :

Customer billing details

BT will contact the customer for payment details
Please confirm that the customer has accepted the BT Openworld Terms and conditions and Privacy Policy for the service	Yes	No

Does the customer wish to receive BT information regarding new products/ special offers?	Yes	No

Does the customer wish to receive information from other companies ?	Yes	No

Customer preferred registration details

THE CUSTOMER WILL NEED A USER NAME AND PASSWORD TO LOG ON FOR EMAIL*
*The user name must only contain letters, numbers, a full stop or dash
Customer's preferred choice of user name is :
Customer's choice of password is :
(Password must be between 8-16 characters long and include at least 1 number.It should have no spaces or punctuation)

Customers security question
What is your Date of Birth? :(dd/mm/yyyy)
What is your mother's maiden name? :