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Gonuts4free BT ADSL 2 Mbit

The following form will ask you about personal contact, technical and billing details. Please fill out the form with most highest detail. Detailed and correct information is important for the ADSL activation process. All information that you provide is treated with the most highest security and confidentiality.

Should you have any questions or would like to contact a support member from Gonuts4free regarding this ADSL service, then please call 807 51 70 45 (Spain only).

Note:

	Required field. (Red color.)
	Optional field. (Green color.)

1. Personal contact Details:

	Full Name :
	Contact Telephone nr. :
	Contact Mobile nr. :
	Fax nr. :
	Email Address :

2. ADSL & Technical Details:

Telephone nr. where ADSL should be installed or activated on :

Is the above mentioned telephone line analog or digital ? :

Have you requested ADSL before on the above nr. with another Internet Service Provider ?

Would you like to have a fixed IP address with your ADSL ? : ( + 12.00 Euros/Month)

What operating system do you have installed on your computer ? :

ADSL Speed :

(Click here if you would like to change speed...)

ADSL Equipment :

How many computers would you like to connect to your wireless system ?

(only specify if you have selected a Wireless Router Vigor 2600 above).

Would you like a technician to visit you and arrange the installation for you ? ( + 99.50 Euros)

3. Billing Details:

	Name :
	Surname :
	Type of ID Document :
	Nr. of ID document :
	Full Home Address :	(Not Apartado)
	City/Town :
	Postal Code :
	Province :
	Method of payment :
	Owner of account :
	Bank code:
	Bank Account nr.	/ /

4. Additional comments or information regarding your ADSL activation:

I agree to the terms and conditions of Gonuts4free and confirm that the above information is correct in order to activate the ADSL service on my telephone line. I also agree that by requesting this ADSL service I accept the following costs for this type of line as presented on the following page: (click here)

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