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SDSL Order Form
All fields are mandatory.
Contact Name:
Contact Telephone number:
Contact email address:
Company:
Address:
(of the SDSL line)
Town:
County:
Postcode:
Billing Address:
(only if different)
SDSL line type:
Business 5000 (10:1)
Business 5000 (5:1)
Business 5000 (1:1)
Business 1000 (10:1)
Business 1000 (5:1)
Business 1000 (1:1)
Business 500 (10:1)
Business 500 (5:1)
Business 500 (1:1)
Business 250 (5:1)
Business 250 (1:1)
Preferred installation date.
Day:
Month:
[Select One]
January
February
March
April
May
June
July
August
September
October
November
December
Year:
If reseller:
Reseller name:
Reseller contact:
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Interactive Advertising Limited 1995-2012
