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N3 PSN Order Form

 
 *  Site ODS code:  
 *  Access Agreement number:  
Primary customer contact
Please tell us who we should contact about this order.
 *  Name:  
 *  Job title:  
 *  Postal Address:  
 *  Telephone number:  
 *  Email:  
Secondary customer contact
Please tell us who we should contact if the primary contact is not available.
 *  Name:  
 *  Job title:  
 *  Postal Address:  
 *  Telephone number:  
 *  Email:  
Billing information
Please provide details of who will be funding the N3 product or service.
 *  Organisation name:  
 *  Organisation address:  
 *  Organisation postcode:  
Site details
Please provide details of where the N3 service will be installed.
     (same as above)  
 *  Site name:  
 *  Site address:  
 *  Site postcode:  
Location details
We need to know exactly where to install your N3 service.
 *  Building name:  
 *  Floor:  
 *  Room number:  
Primary site contact details
Please tell us who we can contact at the site.
 *  Site contact name:  
 *  Site contact job title:  
 *  Site contact telephone number:  
 *  Site contact email:  
Secondary site contact details
Please tell us who we should contact on site if the primary site contact is not available.
 *  Site contact name:  
 *  Site contact job title:  
 *  Site contact telephone number:  
 *  Site contact email:  
Order details
Please provide details of the N3 product or service you’d like to order. If you require a connection over 10Mb, please contact the N3 Helpdesk on 0800 085 0503 Opt 3 and we can assist you.
 *  Catalogue service number:  
  BT PSTN number (mandatory if ordering N3-1-17):  
 *  Main service and speed:  
 *  Back up service and speed:  
 *  Lead time:  
 *  Date you’d like the connection installed by (please bear in mind the lead time above):  
 *  Opening hours  
Additional information
Please enter any other details that might help us provide your N3 service
  Enter additional information:  
 
If you have any enquiries about this order please contact the N3 Provisioning Team on 0800 085 0503 (select option 2, then option 1).