VoIP_Agreement

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VoIP Agreement Form:

Name:

Phone:

Fax:

First Name:

Last Name:

Title/Position of Authority:

E-Mail:

Phone:

Extension:

First Name:

Last Name:

Title/Position of Authority:

E-Mail:

Phone:

Extension:

Apt/Suite:

House #:

Street Name:

City:

Province:

Postal/Zip Code:

Apt/Suite:

House #:

Street Name:

City:

Province:

Postal/Zip Code:

Pilot (Main) TN:

Current Local Provider:

Installation Type:

Router Model:

Router MAC Address:

Current Internet Service Provider:

Internet Service Speed, Package, Options, Planned Upgrades:

Additional hardware and/or services provided:
*Please see installation invoice for complete details

LAN Ports OK:

LAN Piggyback:

Summary of Additional Hardware/Installation & Notes:

Plan:	Soft Cap Quota:	Plan Soft Cap:	Supplier:







Please note, Set Up is non recurring, Services Total does not include additional services, hardware etc. which will be detailed on work orders & invoices.	SERVICES TOTAL:	Overage per minute:	Toll Free per Minute:

Partner/Associate:

Seller Name:

Seller E-Mail:

Seller Phone:

Seller Extension:

VoIP Agreement Form:

Company:

Primary Contact: (Signing / Billing)

Secondary Contact: (Site / Technical)

Physical Address:

Billing Address:

Site Information:

Router Information:

Internet Information:

Other Information:

Service Information:

Seller Contact Information:

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