Change of ISP connection

Contract for Change of ISP connection

I (the reader and duly authorised person) hereby apply for the supply of a network connection and services in accordance with CityLink's standard terms and conditions. I declare that I know of no debt owing to CityLink in respect of previous failure to pay and I agree to pay for all services and connections as set out in the Supply Agreement. I agree to give at least one month notice of intention to vacate, disconnect or reconnect the premises or services.

I understand that any personal information given by me is for a lawful purpose and will be used solely for the purposes of managing and supplying network connections and services and the business of CityLink, and I have a right of access to, and correction of, that information.

Transmission of a completed Customer Application Form constitutes an order for supply of services and will be acted upon by CityLink. Fax to 04 385-9004 or post to PO Box 9328, Wellington

Application form

Required fields are labelled as (required).

Full company Name: (required) Trading Name: (required) Client Order Number: (required) Change Requirement Date
NB: Date must be the final day of a calendar month due to billing: (required)

Current Internet Service Provider (ISP) details Current Internet Service Provider (ISP): (required) Date that the Current ISP was notified of this change: (required)

Person Notified: (required) Email: (required)

New Internet Service Provider (ISP) details New Internet Service Provider (ISP): (required) Date that the New ISP was notified of this change: (required)

Person Notified: (required) Email: (required)

Current Connection Circuit Number: (required) Connection Type: (required) Building name: (required) Floor no.: (required) Street no.: (required) Street name: (required) City: (required) Comments:

Optional Second Connection (if applicable) Circuit Number: Connection Type: Building name: Floor no.: Street no.: Street name: City: Comments:

Optional Third Connection (if applicable) Circuit Number: Connection Type: Building name: Floor no.: Street no.: Street name: City: Comments:

Optional Fourth Connection (if applicable) Circuit Number: Connection Type: Building name: Floor no.: Street no.: Street name: City: Comments:

Invoicing contact details

Invoice the ISP for all connections?: (required)

Company name: (required) Contact person: (required) Company position: (required) Invoice postal address: (required) Billing contact phone: (required) Billing contact fax: Billing contact email: (required)

Services order agreement

I hereby order the services I have indicated above and agree to abide by the CityLink Standard Terms and Conditions dated 13 March 2006

Name: (required) Position: (required) Date: (required)

Email: (required)
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Last updated 07/07/09 | Created 14/08/2007