FS - Technicians Form

Technician's Ref.number
Customer Acct Number
Name of INTRODUCER
Name(s)
Surname(s)
Email
NIE Nº.
Telephone Number
Mobile Number
Address
Post Code
Antennae Details
Serial Number
IP Address
MAC Address
Router Details
Serial Number
IP Address
MAC Address
IPTV BOX Details
Serial Number
IP Address
MAC Address
PACKAGE DETAILS
Select Service Required

Select Service Required 3MB @ 39.90€ +IGIC 6MB @ 49.90€ +IGIC 8MB @ 59.90€ +IGIC
Package Option

Package Option ADSL (WiMAX) + IPTV ADSL (WiMAX) SWALLOWS - ADSL(WiMAX) & IPTV SWALLOWS - ADSL(WiMAX)
Monthly Payment Method

Monthly Payment Method Debit Card Cash Direct Debit
Please indicate suitable times for installation.

Please indicate suitable times for installation. 09:00-12:00 hrs Weekdays 12:01-17:00 hrs Weekends 17:01-20:00 hrs Any time
Bank Account Number (4-4-2-10)
4 digits
4 digits
2 digits
10 digits
IBAN CODE : 24 Characters.
ESxx , plus Bank Account Nº ( 20 Digits 4-4-2-10 )
Direct Debit Card Details
4 digits
4 digits
4 digits
4 digits
Expire Date (MM/YY)
CVV (3 digit security code)
Comments - Please confirm total amount charged to client. Any non-standard installation, can be charged at 35€ per half hour or 50€ per hour, plus IGIC and materials.
Client payment must be paid in TIS office, banked or transfered to :
THOR TELECOM CIF : B54773726 _______ SWIFT Code: BSABESBB
IBAN Number : ES85 0081 1442 1300 0109 1910
INSTALLATION COSTS :
ADSL/MiMAX & IPTV - 250€+IGIC(17.50€) = 267.50€ for standard install.
ADSL/WiMAX alone - 180 +IGIC€ (12.60€) = 192.60€ for standard install.
Standard Install includes Antennae, router, 5m of cable, IPTV box if required and any fixing bracket and/or clips.
Non-standard installation chargeable to client @ 35€ +IGIC (2.45€) per half hour or 50€ +IGIC(3.50€) for full hour, plus any extra materials, plus IGIC.
All prices correct at time of issue.
Type the letters you see in the image below.

FS - Technicians Form

FS - Technicians Form

Antennae Details

Router Details

IPTV BOX Details

PACKAGE DETAILS

Bank Account Number (4-4-2-10)

Direct Debit Card Details