Information Request (Connectivity)

Information Request (Connectivity)

Connectivity Orders - Information required to proceed with your order
Company Name*
Site Contact Name *

First NameLast Name
Phone Number*

Area CodePhone Number
Mobile Number*
Please enter a valid phone number.
Site Access*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option

Address of Installation
Address*

Street Address

Street Address Line 2

CityCounty

Postal Code
Location of Installation
Floor*
Ground Floor, 1st Floor etc.
Room*
Comms Room1, Comms Room2 etc.
Rack Location*
Number/Position (top/middle/bottom) etc..
How is the Router to be Installed*
Is the Termination Area / Comms Room Ready?*

YesNo
When will the Comms area be ready?

DayMonthYear
Date
Are you happy to install the supplied Router?*

YesNo
How many Public IP Addresses are required*
Typical IP available are 1,2,4,8,16.32+

Building Details
Does the Site have Power / Location of Internet based Services?*

YesNo
When do you expect to have power at the location?

DayMonthYear
Date
Has Landlord consent been granted? (if required)*

YesNoN/A
If required, when do you expect Landlord consent to be granted?

DayMonthYear
Date
Landlord Full Name:
Landlord Phone Number

Area CodePhone Number
Landlord Email
example@example.com

Address of Installation