Please write in BLOCK LETTERS
Serial No.
Ref. CRF #
Customer Details:
Title
Mr
Mrs
Ms
First Name
*
Middle Name
Last Name
*
Company(if applicable)
Contact Person(if applying on behalf of company)
Designation/Occupation
Nationality
NIC/Passport No.
*
Phone(s)
(office)
(residence)
(mobile)
Fax
Email
*
Billing Address
*
Street & City
Installation Address
*
Street & City
Service Details
*
Internet
Data
Metro Last Mile
Voice
(
Fixed Line
SIP
PRI
PABX
)
Hosting: (
Web
FTP
DNS
)
Others
Service Plan Selected
Other Details, (if any)
User Name (Depends upon availability)
(Option 1)
(Option 2)
(Option 3)
Charges Details:
One Time Charges
Service/Equipment
Cost
GST 15%
Others
Total
Installation Charges
ONT Charges
CPE Charges
IP MUX
Other Charges (if any)
Security (Refundable)
VAS Charges
Cabling/Civilwork
Total
Monthly Charges
Services
Internet
Data
Metro Last Mile
Voice
Others
Total
Monthly Package Cost
(Payable in Advance)
Total
Customer’s Declaration:
I hereby undertake and commit not to transfer/handover/sublet my FTTU/FTTH connection (even temporarily) to any person who may attempt to use it for any unlawful activity as described in Terms & Conditions. If I do so, I will be liable and fully responsible for all obligations under the law and ConnecTel will NOT be responsible. Any unauthorized transfer/use of the connection shall entitle ConnecTel to terminate my connection forthwith. I hereby certify that the information given in this form is correct. I have read and agreed to the Terms & Conditions of this agreement as stated on the reverse side. I undertake that the service provided by ConnecTel would not be used contrary the provisions of Pakistan Telecommunication (Reorganization) (Amendment) Act, 2005 and Pakistan Electronic Media Regulatory Authority Ordinace, 2002. If such is the case, ConnecTel has the right to disconnect my service immediately without any notice.
Date
Customer’s Signature
For office use only
User Name allocated
Telephone # allocated
Sales Representative
Sales Manager
This service is to be used within Pakistan LTR (S/N) regions code (042) only. The company reserves the right to disconnect the services without
giving notice or assigning any reason if the user is found violating the terms and conditions of the service agreement.
I accept the
Terms & Conditions
141-143 Maulana Shaukat Ali Road, Lahore, Pakistan
Office Tel: +92 42 3517 1070-71, +92 42 32530100-04, Sales Tel: +92 42 32530100-04
Email: sales@connectel.com.pk, Website: www.connectel.com.pk
connecting
networks