Request for Upgrade of CityLink Ethernet Service

I (the reader and duly authorised person) hereby apply for the upgrade of a network connection and services in accordance with CityLink's standard terms and conditions and the currently issued Schedule of Services and Charges. I declare that I know of no debt owing to CityLink Ltd in respect of previous failure to pay and I agree to pay for all services and connections as set out in the current CityLink Schedule of Services and Charges. I agree to give at least 1-month notice of intention to vacate, disconnect or reconnect the premises.

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 name of Client Company requiring CityLink Service : (required) Trading Name: (required) Client Order Number: (required) Upgrade requirement date: (required)

Name of company arranging service if other than actual client company: CityLink Quotation Reference: (required) What is the company's main business activity?: (required)

Contact Person for this Order Contact Person Name: (required) Contact Person Phone: (required) Contact Person Email: (required)

Present Connection Type Circuit#: (required) Product: (required) Address of Service: (required) Connection Type: (required)

Upgrade Required Connection Type: (required) Comments:

Location of Upgrade Site Floor no.: (required) Street no.: (required) Street name: (required) City: (required)

On Site Contact Contact Name: (required) Contact Phone Number (s): (required)

Upgrade Fee: New Monthly Fee:

Contract Term:

24 months
36 months

Technical contact details Technical contact name: (required) Position: (required) Technical contact phone: (required) Technical contact fax: Technical contact email: (required)

Building detail if known Building manager name(s): Building manager phone: Building manager location: PABX room on floor no.(s):

Invoicing contact details 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

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

Email: (required)
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Last updated November 2008 | Created 16/01/09