Digi
Digi Telecommunications Sdn Bhd (201283-M)
Lot 10, Jalan Delima 1/1, Subang Hi-Tech Industrial Park
40000 Subang Jaya, Selangor Darul Ehsan
Tel: 016-2211800
SERVICE ACCEPTANCE FORM
Please use Capital Letters for Name, Address and Equipment Information
Service Order ID
*
Customer Name
*
Customer Email
*
example@example.com
Contact Number
*
Site Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Distance to Site
*
Within 100km
101km - 200km
201km and above
Google Map Screen Capture
*
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You are required to provide Google Map for distance above 101km
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of
Speed
*
50 Mbps
100 Mbps
300 Mbps
500 Mbps
800 Mbps
1 Gbps
Testing
A
B
C
Type of Customer
*
Mass
Corporate
Nature of Work
*
New Installation
Maintenance
Returned Order
Installer Company Name
*
Installer Name List
TDC
CTS
ALLO
Samudra
WCWL
Solara
Respondtrade
Installer Name List (test)
A
B
Installer Company Email (default)
Subcon Company Email
*
example@example.com
Installer Name
*
Installer Signature
*
Equipment Information
Download Speedtest (LAN)
*
Numeric with 2 decimal places
Upload Speedtest (LAN)
*
Speedtest Picture (LAN)
*
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of
Download Speedtest (WiFi)
*
Upload Speedtest (WiFi)
*
Upload Speed
Speedtest Picture (WiFi)
*
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of
Radius ID
*
Router Model
*
ZTE ZXHN H198A
Zyxel EX3300-T0
D-LINK DIR-842
Router Serial Number
*
Router Serial Number Picture
*
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of
Modem Model
*
ZTE ZXHN F600
Other
Modem Serial Number
*
Modem Serial Number Picture
*
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of
Splitter Port Number
Not Applicable
Remarks as below:
Extra Cabling
Not Applicable
5m
10m
20m
Other
Installer Remarks:
Date Completed
*
-
Day
-
Month
Year
*Below section to be filled up by Customer
Declaration
*
I hereby confirm that the equipment/service installation/maintenance is acceptable and to my satisfaction.
Customer's Signature
*
Customer Name
*
Customer I/C Number
*
Date
*
-
Day
-
Month
Year
Customer's comment
Disclaimer. Please note that this form is part of the general Terms & Conditions, all work shall be deemed completed and billing instruction shall proceed to you accordingly.
Terms and Conditions
Serial Number
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