Submit Form
FAULT REPORTING
COMPANY NAME
CONTACT NAME
FAULTY CONTACT NUMBER
ADDRESS
POST CODE
STATE
FAULT DETAILS
DIAL TONE
Please Select
YES
NO
NOT SURE
STATIC CRACKLING NOISE
Please Select
YES
NO
NOT SURE
MAKE OUT GOING CALLS
Please Select
YES
NO
IS THERE AN ADSL ON THE LINE
Please Select
YES
NO
HAS AN ISOLATION TEST BEEN DONE
Please Select
YES
NO
If PABX system, has the equipment been checked by their maintainer?
Please Select
YES
NO
If fax machine is connected, was a normal handset tried?
Please Select
YES
NO
E-mail
Should be Empty: