Request For Service

Customer Details

Contact Details

Name:

Name:

Address:

Position:

Phone:

*

Fax:

Postcode:

Email:

*

* denotes a required field

Your Telephone Numbers

Please list below the FULL telephone number (inc. STD code) for EVERY line (voice, fax, data etc) on which the service is to be provided:-

Technical Information

If you have a telephone system (PABX), please give make & model details and indicate whether it has alternative routing facilities.

(Leave blank if uncertain)

Billing & Management Information

TeleFoniX automatically provides a fully detailed analysis of every call made on your account each month. To reduce the volume of paper received, you may elect to receive the analyses & management reports on disc and/or to aggregate calls below an individual value specified by you.

Please indicate if you require to receive the information on disk:

(Tick for yes)

Specify here the call value below which you require calls to be aggregated.

(Leave blank if uncertain)

Payment Arrangements

Monthly invoice, payable within 14 days. Service may be suspended without notice if two or more invoices are overdue.

Payments may be made by post to

TeleFoniX (Communications Services) Ltd
23 Kingfisher Court
Walton on Thames
KT12 4LF

or to:

Lloyds TSB Bank plc, 83 High Street, Walton on Thames KT12 IDU

Account: TeleFoniX Global Comms

Account Number: 1878968 Sort Code: 30-99-09