Customer and Service Details

Customer Name

Email Address

Account Number

Service Number

Current Plan

Service Type

Medium

Street Name

Delivery Details

Mobile Contact Number (required)

Please confirm the best mobile number for our delivery team to contact you regarding your modem delivery.

Preferred Delivery Date (required)

Please select your preferred delivery date. Our team will contact you to confirm the final delivery schedule.

Delivery Notes or Remarks (optional)

Examples:

• Nearest landmark

• Preferred delivery time

• Security gate instructions

• Name of the person receiving the modem (if different)

• Any other information that may assist our delivery team