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Dear Customer

Internet Service Order Form

Thank you for requesting anInternet service.

Please find attached our formal order form for Internet access at your location. Please check the form – feel free to contact us if anything is unclear or incorrect.

You should also check our ‘Terms and Conditions’ and ‘Acceptable Use Policy’which form part of the contract.

To complete the order we ask you to sign the final page in full.

Once done, either scan and email to {EMAIL ADDRESS} or deliver to {PHYSICAL ADDRESS}.

When we return the completed contract to you, we will invoice you for anystandard Setup Charge that might be applicable, which you should pay before we commence service.

Points to note with respect to Internet Service contracts

For new service connections, there may also be a charge for cabling services. We may sometimes estimate this charge to expedite service. Where this is the case, you will see it marked on the form. Should the estimate be substantially exceeded, we will pause delivery and consult on whether you still wish to proceed.

This is in addition to any service set up charge that might be applicable.

For more details on getting connected and all services please consult the document “Provision and FAQs”.

Once signed the contract cannot be cancelled by you except for the specific reason above.

We look forward to delivering a great service for you.

Best Wishes

Internet Order Form

  1. Customer Details

Company Name
  1. Customer Contact details

YOUR ROLES / Name / Email / Telephone
Order Authority
Operations & IT contact
Billing Contact
  1. Site of Installation

Company name at Site
Building
Floor and Suite/Office #
Floor and Room for network termination for incoming service in your office
Contact Onsite
Onsite email address
Phone number of contact on site
Out of Hours contact if supplied

Type of Service - Select one of 3, 4, or 5 below.

3. Shared Bandwidth Service Order

See Handbook for service specifications

Service Setup / Monthly Charge
Shared Service Plan Level / ☐Entry Level Service / £ 0 / £0
☐Premium Level Service / £65 / £65
Cabling and provisioning / ☐Estimated cost – or -
☐Confirmed cost / -
  1. Guaranteed Bandwidth Service Order

See Handbook for service specifications

Bandwidth Mbps
Down / Up / Select Service / Set up / Monthly term
(default) / Annual term,
per month
☐ / ☐ /
2 / 2 Mbps / ☐ / £300 / £180 / £160
5 / 5 Mbps / ☐ / £300 / £255 / £230
10 / 10 Mbps / ☐ / £300 / £395 / £355
20 / 20 Mbps / ☐ / £300 / £695 / £625
30 / 30 Mbps / ☐ / £300 / £875 / £795
Other / ☐ / £POA / £POA / £POA
Optional Burst on Guaranteed Bandwidth
10% of monthly charge for every 20% of guaranteed bandwidth. Subject to resource availability
Indicate burst bandwidth as % of Guaranteed bandwidth above / ☐+20% of guaranteed
☐+40% of guaranteed
☐+60% of guaranteed
☐+80% of guaranteed
☐+100% of guaranteed
  1. Failover-Only Guaranteed Bandwidth Service

See Handbook for service specifications

Bandwidth Mbps
Down / Up / Select bandwidth for Service / Monthly Charge for use up to allowance / Set up / Allowance / Month
/ Charge on use of Failover (exceeds Allowance)
2 / 2 Mbps / ☐ / £85 / £300 / 10GBytes / 200% of equivalent
Guaranteed bandwidth rate
5 / 5 Mbps / ☐ / £85
10 / 10 Mbps / ☐ / £85
20 / 20 Mbps / ☐ / £85
30 / 30 Mbps / ☐ / £85
Other / ☐ / £POA / £POA / £POA
  1. Optional Public IPs – all services

Qty / Rate / Month
Number of Single Public IPsRequired (1-3) / ☐1 Public IP / £15/month
☐2 Public IPs / £30/month
☐3 Public IPs / £45/month
Subnet of Public IPs / ☐POA subject to justification
  1. Declaration and Signature

Please check the information on this Order Form and complete any missing details.

THE CUSTOMER HEREBY ACKNOWLEDGES THAT HE/SHE HAS READ THIS DOCUMENT AND THAT BY SIGNING HE/SHE ACCEPTS THE TERMS AND CONDITIONS AS FOLLOWS:

  1. The General Terms and Conditions
  2. Acceptable Use Policy

Which form an integral part of this order form and Customer’s contract with Edinburgh Technopole.

Signed by a Duly Authorised Representative of Customer in 1 Above / Signed by a Duly Authorised Representative of Supplier on behalf of Edinburgh Technopole
Name / Name
Position / Position

Date as signed

Medusabusiness : Internet Service Order Form– Issue 1