Line Details

What is the telephone number of the line you wish to convert to ADSL:   STD Code: *   Number: *

In whose name is the telephone number held: *

Address of Telephone number?

Company Name (if applicable):

Address:

Town:    County:   Postcode:

Contact Telephone no:   Email Address: *

* Required details (the form cannot be processed without this information)

• Option 1. Professional 500k/250k (ethernet connection)
• Option 2. Professional 1000k/250k (ethernet connection)
• Option 3. Professional 2000k/250k (ethernet connection)

Additional Services: Please Select Option 4. 10-user Firewall Option 5. 50-user Firewall Option 6. VPN upgrade Option 7. PGP remote access for Mac Option 8. VPN remote access for PC Option 9. Domain name hosting Option 10. Internet dialup accout, 10mb web space Option 11. SMTP mail forwarding

Technical Information

What equipment will you connect to your ADSL line?

Main computer (make, model, specification):

Operating System: Windows 95 Windows 98 Windows ME Windows NT Windows 2000 Windows XP Mac OS 8.6 - OS 9.X Mac OS X Other

How many Computers will be using this connection: 1 2 - 5 5 - 10 10 - 20 20 - 30 30 - 40 40 - 50 50+

Do you have a Firewall for this connection: No Yes

Do you require an engineer to assist with installation: No Yes (£150.00 Central London)

Would you like us to contact you regarding any technical issues - e.g. Firewall, router supply or configuration: No Yes

Company Information

Number of employees: 1 - 5 5 - 10 10 - 20 20 - 30 30 - 40 40 - 50 50+

Turnover: optional £50k - £100k £100k - £200k £200k - £300k £300k - £400k £400k - £500k £500k - £600k £600k - £700k £700k - £800k £800k - £900k £900k - £1m £1m +

Industry: Select Music Publishing Production Marketing Accounting Design Other

On receipt of your e-mail, we will check that your exchange is enabled for ADSL and then contact you to discuss your requirements.

Please note:

1. The ADSL installation is made onto the main BT line box (not an extension box).
2. There must be a double power socket available (or 2 plug extension lead) within 6 feet of the main BT line box.
3. Fax machines and modems on the analogue line used as an ADSL carrier may be adversely affected.
4. BT advise that they are not able to guarantee that the ADSL installation will be successful. The insallation may fail due to local conditions which do not become apparent until the installation is attempted. The connection charge on failed installations will be refunded in full.