Telephone and ISDN Order Form

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Telephone and ISDN Order Form

New Line (Tel)New Line (ISDN)Line TransferMiscellaneousValue Add Services







1. Personal Informaion:

Mr.Mrs.Ms.


Telephone/ISDN Service Number
Name:
Nationality:
Identity No. (CPR):
E-mail Address:
Facsimile No.
Contact Name:
Tel./ Mobile No.:


Installation Address:

Flat/Shop/Office:		House/Building:
Road No:		Block:
Road Name:

Mailing Address :	(If different than above)

Flat/Shop/Office:		House/Building:
Road No:		Block:
P.O.Box:		Area:

Telephone Directory :

Yes, I would like to publish my number in the telephone Directory No (BD 10/- will be charged once-off)

The name as it should appear in the dircetory entry:
- -


2. Telephone Services
Are you a residenatial or a business customer? ResidentialBusiness
Number of Lines		Number of Sockets:
	(Additional sockets = Extra charge)

3. Integrated Services Digital Network "ISDN"

ISDN Lines Basic Rate Access ISDN Lines Primary Rate Access
Number of Lines
No. of required Channels for Primary Rate Access
102030
Multiple Subscriber Number "MSN/Direct Dialling In" Quantity :


4. Line Transfer

Flat/Shop/Office:		House/Building:
Road No:		Block:
Road Name:
Disconnection date at the existing address
Please tick if Called Number Announcement (CNA) is required, this service is at charge

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