Faircom Cancellation Request Form

Faircom Cancellation Request Form
Please complete all information below:
Please choose one of the following:

Are you a Faircom Customer?Are you a Faircom Staff Member?
Name*

First NameLast Name
E-mail*
Phone*
Address(include Unit and Building Name)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Wifi SSID or Username*
Provide your wifi name or PPPOE username
Account Number*
* This can be found on your monthly Statement on the top right hand corner
Faircom Client type*
Tenant: Agent/Owner Name & Surname*
Tenant: Agent/Owner Email Address*
example@example.com
Tenant: Agent/Owner Contact number*
Please enter a valid phone number.
Building Name*
Fibre Provider*
Last Day of Active Service *

DayMonthYear
*Please note that a calendar months notice must be given. Should this agreement be terminated within the first 24months, you will be liable for the repayment of the installation cost or a prorata portion thereof. Should you be on an Open access providers' fibre infrastructure, i.e Openserve.
Provide reason for cancellation*
Cancellation comments*
Router Option*
Where a free to use router (FTU) has been provided to a client and the services are cancelled / terminated, the client must liaise for return of the FTU router with the Faircom Team. The Client to ensure that the router is in good working condition. Should the router not be returned / not in working condition the client will be held responsible for the replacement cost thereof.
Are you staying with Faircom?*

YesNo
Enter new address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owners or New Tenant's details
*If you know who the owner of the unit is or you know who the new tenant will be please provide us with the contact details so that we can get them connected through Faircom.

ADMIN ONLY SECTION
Does the client have a FTU router or any other FTU equipment?*
Open Access client?*
Client line has been cancelled on Open Access supplier portal?*
Client has been notified of FTU return policy + pending charge if not adhered to*
Client has been notified of remaining balance of installation/activation charge?*
Open Access cancellation reference number*

FINANCE ONLY SECTION
Client service date updated?*
Client inactive date set?*
Invoiced client for notice period?*
Invoiced client for any FTU charges? (4th of following month)*
Contract cancelled within initial 12 month period?*
Invoiced client for remainder of installation/activation fee?*
Invoice Number for abovementioned charges*
Added cancellation JotForm link to customer notes?*
Client informed of the 30 day/1 calendar month notice period & charge*
Should be Empty:

Faircom Cancellation Request Form

ADMIN ONLY SECTION

FINANCE ONLY SECTION