Faircom Cancellation Request Form
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.
Please complete all information below:
Name
*
First Name
Last Name
E-mail
*
Phone
*
Address(include Unit and Building Name)
*
Street Address
Street Address Line 2
City
State / 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
*
Please Select
Faircape Village resident
Tenant
Owner
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
*
Please Select
Faircom
Octotel
Frogfoot
Openserve
Century City Connect
Vumatel
Linteg
Last Day of Active Service
*
-
Day
-
Month
Year
*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
*
Please Select
Unit sold
Moving with no coverage
Affordability
Cheaper ISP Option
Network issues
Insufficient technical support
Customer Deceased
Poor Customer service
Company providing Internet
Emigrating/Out of Province
Move to Healthcare
Cancellation comments
*
Router Option
*
Please Select
Free to Use(FTU)
Purchased from Faircom
Personal
Are you staying with Faircom?
*
Yes
No
Enter new address
Street Address
Street Address Line 2
City
State / 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.
Back
Submit
Next
ADMIN ONLY SECTION
Does the client have a FTU router or any other FTU equipment?
*
Please Select
Yes
No
Open Access client?
*
Please Select
Yes
No
Client line has been cancelled on Open Access supplier portal?
*
Please Select
Yes
No
Client has been notified of FTU return policy + pending charge if not adhered to
*
Please Select
Yes
No
Client has been notified of remaining balance of installation/activation charge?
*
Please Select
Yes
No
Open Access cancellation reference number
*
Back
Next
FINANCE ONLY SECTION
Client service date updated?
*
Please Select
Yes
No
Client inactive date set?
*
Please Select
Yes
No
Invoiced client for notice period?
*
Please Select
Yes
No
Invoiced client for any FTU charges? (4th of following month)
*
Please Select
Yes
No
Contract cancelled within initial 12 month period?
*
Please Select
Yes
No
Invoiced client for remainder of installation/activation fee?
*
Please Select
Yes
No
Invoice Number for abovementioned charges
*
Added cancellation JotForm link to customer notes?
*
Please Select
Yes
No
Client informed of the 30 day/1 calendar month notice period & charge
*
Please Select
Yes
No
Should be Empty: