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Soul ADSL2+ New/Churn
Soul ADSL2+ New/Churn
Is this a New service or Churn?
New service
Churn
Churn
Service Provider Name
Service Provider Contact:
Service Provider Email
Customer Information
Customer Name
First
Last
Service No.
02/03/07/08
ADSL Address
Street Address
City
State / Province / Region
Zip / Postal Code
Service details
Do you require a static I.P?
Yes
No
Username
Request date
ASAP
Specific date
Date
I understand and agree to the charges associated with submitting a this churn request. I have a valid signed CA and will securely store it and will provide to iTelecom Wholesale with 24 hrs of being requested. I understand that the request cannot be cancelled until such time that it is provisioned. I understand that this service may require an upgrade of the End User Equipment and alterations to the End User Equipment configurations settings.
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