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Fields marked in Red are mandatory

Customer Details

	Installation Address	Billing Address (if different)
Your Full name
Company Name
Sub-premises Name
Building Name or Street Number
Street Name
Locality
Town
Post Code

Is there a BT Telephone number at the site ? ( To help with address matching ).
If not please insert any known existing BT BUSINESS number for the Customer.

Existing BT Telephone Number
Are you a new BT customer ?
Is this a Business Mover Order ?
Special Billing Requirements

Contact Details Who is the contact for enquiries regarding this order ?
Contact Name
Telephone Number
Alternative Contact Number (Mobile Number preferred).

Customer E-mail Address
Who will be the on-site contact for the engineers ? (if different from above)
Site Contact Name
Site Telephone Number
Who should correspondence be marked FAO ?

Notes

Order Details Tel number for Broadband service
VOL Reference
MAC (Migration Order)

If an "Overlapping Move", confirm cease date & tel number of the BB line that requires ceasing (once customer has their BB line at new premises)

Existing Tel No
Cease Date
What is your required date for completion of this order?
Broadband Package Required
Install Type (£99 includes 1 PC)
IP Options
Contract Term (Check T&Cs)
Preferred install date/appointment
(5 working days lead time)

Security Details Preferred Username
1st Choice @btconnect.com
2nd Choice @btconnect.com
Password (min 8 characters and must include at least one number)
(Do not use generic passwords e.g. 'Password1' as this causes issues with customers logging into their account and also generates calls to the helpdesk)
Password
Challenge Question
Challenge Answer
Consent The customer consents to BT contacting them for offers and promotions?

I have read and accept the Terms and conditions for BT Business Services and BT Business Broadband access service charges

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