ipNX Internet Service Order Form

ipNX Internet Service Order Form

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Thank you for choosing ipNX FOS!

To sign up, please fill this form and provide all details required. Please note that you will be required to attach statutory documents like your utility bill, personal identification, and passport photograph.

For enquiries/more information kindly call +234-2-01-6330000 or send a mail to telesales@ipnxnigeria.net
What type of Internet plan are you looking for?*

Small & Medium Entreprise (SME) PlansResidential Plans

To show our support to the COVID19 ‘stay at home’ campaign, we are currently waiving installation cost on selected service plans from June 1st to June 30th 2020. Stay connected!

Stay home, stay safe.
TERMS AND CONDITIONS

*Extra costs may apply based on the outcome of a site survey. **Initial payments are to be made via this portal. FOS internet service is a monthly pre-paid service. Service will be delivered within 4 days from the payment date which is subject to the completion of all civil engineering work”.

We guarantee that our FOS optical network terminal (ONT/Modem) which we will give to you will work to the relevant specification for the minimum warranty period of 180 days.
Terms and Conditions

I Agree
Please choose an internet plan*
Price
Internet Plan + Modem & Installation
Do you want to view the promo plans?

YesNo
Internet Plan( Modem + Installation) Old*
PROMO APPLIES - Please choose an internet plan*
Amount *
Number of Month(s)*
Amount to Pay*
One more thing!

Please complete payment before you proceed.

Promo! To show our support during this time of COVID-19, we are currently waiving installation cost from June 1st to June 30th 2020, when you purchase selected plans. Stay connected!

Stay home, stay safe.
TERMS AND CONDITIONS

**FREE modem swap for existing ipNX iWireless Broadband customers.

*Extra costs may apply based on the outcome of a site survey. ** Modems must be in good working condition. Initial payments should only be made by cheque payable to: ipNX Nigeria Limited. FoS Internet service is a monthly pre-paid service. Service will be delivered within 14days from the payment date which is subject to the completion of all civil engineering work. Cheques are only accepted by our field sales representatives.
Terms and Conditions

I Agree
Please choose an internet plan*
Choose number of months*
Price (Internet Plan)*
Total Amount Due*

Who referred you to ipNX*
Kindly let us know who referred you to the ipNX network
Referral Customer ID*
Enter the customer ID of the customer that referred you
Sales Agent*
Which sales agent sold the service to you?
Community Retail Agent*
Select the code of the Community Retail Agent that sold to you
Name*

First NameLast Name
Gender

MaleFemale
Date of Birth

DayMonthYear
Date
Occupation
E-mail*
example@example.com
Mobile Phone*
(NB: Ensure this number is entered during payment)
Alternative Phone Number
Address
Apartment/Flat number
House number
Apartment/Flat number
Apartment/Flat number
House number
Close name
Street name
Estate name
Local Government Areas
Local Government Areas
Local Government Areas
Type of building*

Single Tenant (A single building in a compound)Multi-tenant (Are there more than one apartments in your building, do you live in a twin duplex, block of flats or a unit of a terrace?)
If multitenant, how many units?*
Payment Notice

If the service is being paid for by your
employer, kindly fill the information below, if not, please tick the billing information box.
Billing information

Billing information (if same as above, tick here)
Company
Company Name
Billing Address

Street Address

Street Address Line 2

CityState

Zip Code
Billing Contact

First NameLast Name
Billing E-mail
example@example.com
Billing Phone
Example: (0) 701-2345-678
Upload Passport photograph*

Browse Files
Upload passport photograph (JPEG, PNG) Cancelof
Upload Personal Identification*

Browse Files
Upload driver's license, international passport, National ID card or voters card (JPEG, PNG) Cancelof
Upload Utility Bill*

Browse Files
Upload utility bill either electricity or water (JPEG, PNG) Cancelof
Upload Proof of Payment (ex: bank transfers or tellers)*

Browse Files
Upload proof of payment (JPEG, PNG) Cancelof
Personal Data Processing Consent

ipNX will collect and process your personal data to provide the services you subscribed to. This may involve the transfer of your personal data to our subcontractors and other third parties where necessary. For further information on how we may use your personal data please refer to our Data Privacy Policy.

I have read and understood the information here and in the Privacy Policy. I hereby consent to the use of my Personal Data by ipNX for the purposes outlined above.
Personal Data Processing Consent*

I Give My Consent
Click to Read
Data Privacy Policy

X
Purpose

To seek your consent to allow ipNX to collect and use your personal data (which includes for example name, address, and email address) for the reasons stated below. You can also give consent electronically via our website

Who Are We?

The name of the organization asking you for consent to use your information is: ipNX Nigeria Limited

What Will We Do With Your Information?

Customers
ipNX will collect and process your personal data to provide the services you subscribed to. This may involve the transfer of your personal data to our subcontractors and other third parties where necessary. For further information on how we may use your personal data please refer to our Data Privacy Notice

Job Applicants /Candidates
ipNX will collect and process your personal data to process your application for employment with us. This may include shortlisting you for interviews, seeking references, and/ or the transfer of your personal data to other third parties where necessary. For further information on how we may use your personal data please refer to our Data Privacy Notice

Data Subject's Statement
I have read and understood the information here and in the Privacy Notice. I hereby consent to the use of my Personal Data by ipNX for the purposes outlined above.

Right To Withdraw Consent
You have the right to withdraw the consent you are giving in this form at any time. You can do this by sending an email to privacy@ipnxnigeria.net or by writing to ‘The Data Protection Officer’, ipNX Nigeria Limited, 4 Balarabe Musa Crescent, Victoria Island, Lagos.
Data Privacy Policy*

I Agree

Who referred you to ipNX*
Referral Customer ID
Enter the ID of the customer who referred you
Sales Agent*
Which sales agent sold the service to you?
Company Name*
Full Company Name
Company Address*

Street Address

Street Address Line 2

CityState

Zip Code
Type of Business
Type of building

Single OfficeMultiple offices
If multiple offices, how many companies?
Contact Person Name*

First NameLast Name
Contact E-mail*
example@example.com
Mobile Phone*
(NB: Ensure this number is entered during payment)
Contact Phone*
Example: (0) 701-2345-678
Other Number
Billing information

Billing information (if same as above, tick here)
Billing Address

Street Address

Street Address Line 2

CityState

Zip Code
Billing Contact Person

First NameLast Name
Billing Contact E-mail
example@example.com
Billing Contact Phone
Example: (0) 701-2345-678
Upload Passport photograph of contact person*

Browse Files
Upload passport photograph (JPEG, PNG) Cancelof
Upload Scan of Letter of introduction from Organisation*

Browse Files
Upload letter of introduction (JPEG, PNG) Cancelof
Upload Personal Identification*

Browse Files
Upload driver's license, international passport, National ID card or voters card (JPEG, PNG) Cancelof
Upload SME's Utility Bill or proof of address*

Browse Files
Upload utility bill either electricity or water (JPEG, PNG) Cancelof
Upload SME's Certification of Incorporation/Registration*

Browse Files
Upload certificate of incorporation/registration (JPEG, PNG) Cancelof
Personal Data Processing Consent

ipNX will collect and process your personal data to provide the services you subscribed to. This may involve the transfer of your personal data to our subcontractors and other third parties where necessary. For further information on how we may use your personal data please refer to our Data Privacy Policy.

I have read and understood the information here and in the Privacy Policy. I hereby consent to the use of my Personal Data by ipNX for the purposes outlined above.
Personal Data Processing Consent*

I Give My Consent
Click to Read
Data Privacy Policy

X
Purpose

To seek your consent to allow ipNX to collect and use your personal data (which includes for example name, address, and email address) for the reasons stated below. You can also give consent electronically via our website

Who Are We?

The name of the organization asking you for consent to use your information is: ipNX Nigeria Limited

What Will We Do With Your Information?

Customers
ipNX will collect and process your personal data to provide the services you subscribed to. This may involve the transfer of your personal data to our subcontractors and other third parties where necessary. For further information on how we may use your personal data please refer to our Data Privacy Notice

Job Applicants /Candidates
ipNX will collect and process your personal data to process your application for employment with us. This may include shortlisting you for interviews, seeking references, and/ or the transfer of your personal data to other third parties where necessary. For further information on how we may use your personal data please refer to our Data Privacy Notice

Data Subject's Statement
I have read and understood the information here and in the Privacy Notice. I hereby consent to the use of my Personal Data by ipNX for the purposes outlined above.

Right To Withdraw Consent
You have the right to withdraw the consent you are giving in this form at any time. You can do this by sending an email to privacy@ipnxnigeria.net or by writing to ‘The Data Protection Officer’, ipNX Nigeria Limited, 4 Balarabe Musa Crescent, Victoria Island, Lagos.
Data Privacy Policy*

I Agree
DECLARATION

I/We hereby apply for the FoS Internet service as per details furnished above and agree to take the service, if offered, on the terms and conditions agreed at www.ipnxnigeria.net, which I/we have read and understood. I/we confirm that the information furnished above is correct. In the event that the information is found to be incorrect, ipNX Nigeria Limited shall have the right to terminate the service, and I/we shall have no claims whatsoever against ipNX Nigeria Limited. I/We also agree to provide a trusted person or party to supervise any technical work at the location specified above and acknowledge that ipNX will not be responsible for any security incidents before or after such work is carried out.
Declaration*

I Agree
Should be Empty:

ipNX Internet Service Order Form

One more thing!

Payment Notice

Purpose

Who Are We?

What Will We Do With Your Information?

Purpose

Who Are We?

What Will We Do With Your Information?