Customer Application Form

Passage Telecommunications Contract Agreement

Business Name: *

Supply Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Tel: *

Area Code Phone Number

Fax:

Area Code Phone Number

Mobile:

Area Code Phone Number

E-mail: *

Billing Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Type of Business:

Registration Number:

Years in Trading:

PRODUCT DETAILS

Products:

Type:

2.

3.

4.

Tel lines for the above product(s)

2.

3.

4.

Contract Length:

EXTRAS

Inlcude free unlimited calls to numbers begining 01,02,03,0800, 0845, 0870 & 0871. Anytime, day & Night for £5 extra

Name of Account Holder: *

First Name Last Name

Bank/Building Society Account Number: *

Branch Sort Code: *

Name & full postal address of your bank/building society *

Signed for and on behalf of the customer, having read, understood and accepted the terms of this agreement and having received the Passage Telecoms contract booklet

Full Name: *

Position: *

Date:

Month Day Year

Signature: (type full name) *

Terms and Conditions:

You have agreed to sign up with Passage Telecoms for the agreed telecommunications services for the period you have indicated above.
You have the right to cancel this agreement without cost during the transfer period.
You will be charged for line rental and calls at the rate that appear in this contract.
A full price list including any updates is shown on www.passagetelecoms.com
You agree to pay all invoices by Direct Debit. You will be charge a £10 administration fee for each invoice you do not pay by Direct Debit. You will be charged interest on any unpaid invoices.
Your agreement with us is for the number of years agreed above, following which service is charged at our standard variable rate.
If you end your contract with us early you will be charged a termination fee of £200 per line/channel for each year or part remaining on contract.
Customer service opening times: Monday to Friday, 9am to 5pm.
Lines services will be transferred typically within 14-28 days.

Line Rental: £12.99 per line/channel per month, Broadband: £15.99 unlimited usage per month. Hosted Voice: £23.99. ISDN: £22.99.

For full price list and call rate, visit www.passagetelecoms.com

*

Tick this button to agree with the above terms and conditions

Payment Details

Confirmation