BTW ADSL2+ & Annex M 12 Month Contract Valid until 30thSeptember 2015 Connection / Migration 1. CUSTOMER DETAILS Customer Name: (as per your bank account name including LTD/LLP/PLC etc) Business/Customer Type: Please tick as appropriate Limited Company *Partnership *Sole Trader Residential Installation Address: (Include company name if different to above) Billing Address if Installation Address is different: On-Site Contact Name: On-site Telephone Number: Mobile Number (Mandatory): E-Mail Address: *If sole trader/partnership please detail name & home address of owner/one partner: 2. TECHNICAL CONTACT DETAILS Name of IT support company: IT support company details: (IT support company/In house contact) Contact Name: Telephone Number: Email Address: ** Please confirm which contact/s should receive email confirmation of DSL live date / connection details: 1. 2. LONDON: THE PRINTWORKS, 139 CLAPHAM ROAD, LONDON, SW9 0HP* TEL: 020 7501 3150 * FAX: 020 7501 3151 MIDLANDS: 40 THE BUSINESS CENTRE, EDWARD STREET, REDDITCH, B97 6HA * TEL: 0121 348 7700 * FAX: 0121 348 7701 Page 1 of 12 3. SERVICE REQUIREMENT - Please check availability with your account manager and circle the box to indicate the service required (+VAT) Please see ADSL info attached sheet – page 7 Service Migration Connection Monthly Rental (Standard Support) Additional Monthly Rental Additional Monthly Rental (Plus support) (Premium Support) ADSL 2+ Standard Free £50.00 £29.00 £10.00 £20.00 ADSL 2+ Premium Free £50.00 £49.00 £10.00 £20.00 ADSL Annex M Standard Free £50.00 £59.00 £10.0O £20.00 (Up to 24Mb down, 448Kb up) BTW (Up to 24Mb down, 1.2Mb up) BTW (Up to 16Mb down, 2.5Mb up) BTW ‘‘Normal Business Use" is defined as traffic that has a bursting profile, i.e. not using the full bandwidth all of the time, with the data being downloaded in the normal conduct of the customer’s business.’ Examples of classes of business or traffic profile that are not considered normal business use include internet café’s, peer to peer file sharing, persistent streaming video or day time offsite backup. If in Spitfire's opinion usage is not normal business use, customer will receive 1 month’s notice to reduce traffic levels and/or alter usage to what in our opinion would constitute normal business use. CIRCUIT UPGRADE: Circuit No: Please list Circuit Number or Contract Number if you are wishing to upgrade your existing Spitfire Circuit. Contract No: 4. EXPEDITE An expedite will endeavour to install an ADSL service within 1-3 working days at a one off charge of £140.00. * Based on best endeavours, cannot be guaranteed. Existing Analogue Line required. * The expedite charge will apply where an ADSL has been successfully connected within 5 working days. * The normal connection charge of £50.00 will also apply unless free connection is offered. Yes / No 5. TOTAL CARE Which Care Level do you require on the ADSL circuit? Please Circle your chosen Care Level Standard Care - £0.00 Standard Care - 40 Clock Hour target clear time. Total Care - 20 Clock Hour target clear time. Total Care Plus - 7 Clock Hour target clear time. Total Care requires 24/7 customer contact and site access. Please provide an out of hours contact name and number. Please note if you don’t select a Care Level Standard Care will automatically be applied Total Care - £9.20 Total Care Plus - £11.50 Contact Name: Mobile Number: LONDON: THE PRINTWORKS, 139 CLAPHAM ROAD, LONDON, SW9 0HP * TEL: 020 7501 3150 * FAX: 020 7501 3151 MIDLANDS: 40 THE BUSINESS CENTRE, EDWARD STREET, REDDITCH, B97 6HA * TEL: 0121 348 7700 * FAX: 0121 348 7701 Page 2 of 12 6. TELEPHONE LINE Yes Analogue line Expedite: One off charge of £185.00. / No Existing BT analogue line numbers to be used for ADSL: Tel No: This line must be a single analogue BT line (not part of a multi line group), presented on a standard BT socket: Yes Would you like Spitfire to take over this phone line? This ensures top level support & faster faults diagnostics. / No Standard line rental is £10.00 plus £1.50 for Service Level 2 per Month Do you need a new analogue line installed? Spitfire will order the analogue line and ADSL as a simultaneous provide which should mean that the ADSL will be live on the day that the line is installed. Simultaneous provides have an approximate 90% success rate, but if they fail, the ADSL will normally be live 7 working days after the line has been installed. Missed Appointments are charged at £100.00. Spitfire must give Openreach 48 hours notice or more when changing or cancelling appointments. Yes / No Installation: £99.00 Standard line rental is £10.00 plus £1.50 for Service Level 2 per month Service Level Options Service Level governs the response time/ target repair time on your line- See Spitfire’s Service Level Agreement for further details. Target repair times are detailed below: Service Level 1: End of Next Working Day plus an additional Working Day, Monday to Friday excluding Public and Bank Holidays. Please Circle your chosen Service Level PLEASE NOTE WE STRONGLY RECOMMEND SERVICE LEVEL 2 OR BETTER FOR BUSINESS USE. SL1 - £0.00 per Month Service Level 2: End of Next Working Day, Monday to Saturday excluding Public and Bank Holidays. This is the default unless otherwise indicated SL3 - £4.50 per Month Service Level 3: End of Next Half Working, Monday to Sunday including Public Holidays. Please note engineers only work 0700 hrs to 2100 hrs SL4 - £5.50 per Month Service Level 4: Clear within 6 hours, any time of day, any day of the year. Please note if Openreach cannot gain access to site out of hours Service Level will reduce to SL1 7. ROUTER Do you require Spitfire to provide a Managed Router? Technicolor TG582n Router: £49.00 Technicolor TG582n Router: suitable for normal usage. Cisco 887 VA-M Router: suitable for more intensive use & provides better fault tolerance & fault monitoring. Yes / No Cisco 887M router: £295.00 Please indicate your preference. Yes / Please confirm if you would like your router to be configured for wireless use: No Yes / No If configured for wireless use, the router will be configured with mixed mode WPA/WPA2 security with a randomly generated password. Please note that Spitfire are not responsible for WiFi coverage and security. Wireless cannot be enables if No NAT configuration is chosen Please confirm delivery address for Router: Please confirm the contact name & daytime number for the person who will accept delivery of the Router: LONDON: THE PRINTWORKS, 139 CLAPHAM ROAD, LONDON, SW9 0HP * TEL: 020 7501 3150 * FAX: 020 7501 3151 MIDLANDS: 40 THE BUSINESS CENTRE, EDWARD STREET, REDDITCH, B97 6HA * TEL: 0121 348 7700 * FAX: 0121 348 7701 Page 3 of 12 8.BACK UP ADSL CIRCUIT Please note that target repair time for all BT Wholesale derived ADSL circuits, regardless of Internet Service Provider is 40 Clock Hours and unfortunately some repairs take much longer. If being without this ADSL circuit for this length of time will seriously affect your business we STRONGLY RECOMMEND that you install a back up circuit. Spitfire offer a Free Back up circuit for all ADSL Premium or Annex M circuits on a 24 month contract and for standard circuits we offer an ADSL Premium Back up circuit for a cost of £10.00 per month or an ADSL Max Standard at a cost of £7.00 per month, with a £50.00 one off installation cost (router available for £29.00). If you require a Back Up ADSL Circuit please complete the supplementary form on page 8 (Sections A1 – A3). If you DO NOT require a Back up circuit please sign the disclaimer below. If you do not require a Back Up ADSL Circuit please sign to confirm you understand and acknowledge that in the event of a fault, repair has a target time of 40 Clock Hours and may take much longer: Signature: ………………………………………………. 9. SECURITY LEVEL Please tick your choice of security level. If opting for password protection, please confirm a choice of password. Password Protection Password: Fax Only Protection No Security Please provide a password for your account. No changes or requests for information will be actioned unless the person making the request can state the password given. Changes or requests for information must be made by fax on company headed paper (or in the case of an individual a copy of a utility bill that identifies them), each time a request is made to change existing service or information is required regarding the service. Anyone claiming to represent the customer can request passwords and changes to the ADSL2+ service by phone, email or fax. This is the default security level. Spitfire will take no action to verify the identity of the person making the request or verify that the request is genuine. LONDON: THE PRINTWORKS, 139 CLAPHAM ROAD, LONDON, SW9 0HP * TEL: 020 7501 3150 * FAX: 020 7501 3151 MIDLANDS: 40 THE BUSINESS CENTRE, EDWARD STREET, REDDITCH, B97 6HA * TEL: 0121 348 7700 * FAX: 0121 348 7701 Page 4 of 12 10. IP ADDRESSES– IPv4 If you require IPv4 please complete the following section If this is replacing an existing Spitfire Circuit would you like to retain Yes – Go to page 6 your DSL connection, username, password and IP address configuration? Please note that port forwards on old Spitfire managed routers No will – Please fill out the below NOT be automatically configured on any new routers. A single Public IP Address is free of charge and is normally used in conjunction with NAT/PAT and port forwarding to provide 253 private IP addresses on the customer LAN. Requests made at a later date will incur the same rental charge plus a £25.00 set-up charge. If public IP addresses are supplied, the details on this form will be used to populate the publicly available RIPE database. PLEASE CHOOSE EITHER NAT OR No -NAT NAT Spitfire Managed Router Defaults: 1 public static IP address, 253 Private IP addresses on LAN To instruct us otherwise please choose and tick from the options below: LAN router IP address is 10.0.0.254/24 DHCP is turned ON The DHCP scope is 10.0.0.1 – 10.0.0.253 NO port forwards are enabled. Disable DHCP My own choice of private IP addresses to be used: Port forwarding: Port number IP address 25 other (please advise) Router IP address IP address range to be served by DHCP. No- NAT For customers who require a No-Nat Configuration there is a standard charge of £1 per month per IP address used. Public IP addresses on LAN As in any subnet, the first IP address is used for the subnet ID and the last for the broadcast ID, the number of usable IP addresses is therefore below. Note that a usable IP address is defined as that available to be used for any router or device including the Spitfire or customer supplied main router. Therefore the monthly /30: £4 per month: /29: £8 per month: /28: £16 per month: charge and the number of usable IP addresses is as follows: 2 usable IP Addresses 6 usable IP Addresses 14 usable IP Addresses Please mark which you require: /30: £4 pm /29: £8 pm /28 : £16 pm YES / NO Will you be returning existing IP address space? If so please state addresses being returned. What equipment will be used and how will it use the requested address space? Example below: Equipment-name: Firewall Manufacturer-name: Cisco Model: ASA 5505 Quantity: 1 IP address Please continue on separate sheet if necessary Equipment-name: Manufacturer-name: Model: Quantity: Equipment-name: Manufacturer-name: Model: Quantity: Equipment-name: Manufacturer-name: Model: Quantity: LONDON: THE PRINTWORKS, 139 CLAPHAM ROAD, LONDON, SW9 0HP * TEL: 020 7501 3150 * FAX: 020 7501 3151 MIDLANDS: 40 THE BUSINESS CENTRE, EDWARD STREET, REDDITCH, B97 6HA * TEL: 0121 348 7700 * FAX: 0121 348 7701 Page 5 of 12 11. IP ADDRESSES – IPv6 Do you require an IPv6 Address? Yes / No Yes / No 12. DOMAIN/EMAIL/WEB HOSTING Do you currently have your domain names/ hosted system with spitfire? If yes please complete supplementary form on page 10 (Sections B1 – B5). 13. TERMS & CONDITIONS o o o o o o o o o o o o o The above information may be used for credit checking purposes. ADSL2+ speed can vary & can be unreliable for the first 10 days, please see page 5. The quoted ADSL services are intended for fast, high quality provision of internet access and email for business use and are subject to Spitfire’s Fair Usage Policy. All Orders are subject to Spitfire’s full terms and conditions, available on our website: www.spitfire.co.uk under Service Level Agreements, ISP Services. If in Spitfire's opinion usage is not normal business use, customer will receive 1 months notice to reduce traffic levels and/or alter usage to what in our opinion would constitute normal business use. If traffic profile is not acceptable or usage moderated at the end of this period, Spitfire will throttle usage to an acceptable level. Goods remain the property of Spitfire Network Services until paid for in full. Payment Terms - Monthly in advance. Rentals will be invoiced and paid in advance of the service period. Direct debit payment for your monthly invoice will be taken on or after the 5 th last working day of the calendar month of invoicing. Minimum term 12 months with 1 months notice required for cancellation thereafter If Primary circuit is ceased within minimum term the customer will be liable for 50% of outstanding charges due over the remainder of the minimum period. These charges will be payable immediately. If the Primary circuit is ceased at any stage, the corresponding Back up circuit will also be ceased unless the customer requests the Back up circuit is upgraded to a normal circuit. If the customer requests a back up circuit is upgraded, standard circuit pricing will apply and a new contract will incept. New contract terms will apply except there will be no connection charges and a new minimum period of 1 month will apply. Please note that the free back up circuit will be charged at the normal price for a standard circuit (£29.00 per month for ADSL2+ Standard) with an equivalent credit to bring the cost down to zero. All prices subject to VAT. Please note a Cease Charge of £39.00 will be applied to your final invoice when you cease the circuit. Please note this charge does not apply to circuits that are migrated to another supplier. 14. CONFIRMATION Please arrange for ADSL to be installed as per the above order. I acknowledge that the above details are correct. I understand that any changes to the above will incur extra charges. It is the responsibility of the end user to cease any circuits or services, which become redundant as a result of the provision of the new ISP services provided by Spitfire. Customer authorised signature: ………………………………………… Date: ………………………………………………………. Customer name (please print): …………………………………………. Position: …………………………………………………. Please note the above information may be used for credit checking purposes. In addition we may ask for further information if required. LONDON: THE PRINTWORKS, 139 CLAPHAM ROAD, LONDON, SW9 0HP * TEL: 020 7501 3150 * FAX: 020 7501 3151 MIDLANDS: 40 THE BUSINESS CENTRE, EDWARD STREET, REDDITCH, B97 6HA * TEL: 0121 348 7700 * FAX: 0121 348 7701 Page 6 of 12 ADSL2+ information sheet – please read Product Types Spitfire offers ADSL2+ using BTW (BT Wholesale) and LLU (Local Loop Unbundled) networks as this allows us to offer ADSL2+ across a much larger geographical footprint and with a wider product range than using BT Wholesale alone. The product types and speed which we provide depend upon which network is available at your local exchange as follows: ADSL2+ Standard is a home user or very small business product. It allows up to 24Mb downstream and 448Kb upstream. ADSL2+ Premium is a business quality product designed to be shared over a network. It allows up to 24Mb downstream and 1.2Mb upstream and is available on both BTW and LLU enabled exchanges. In addition traffic on ADSL2+ Premium is weighted preferentially over ADSL2+ Standard so will provide higher throughput at busy times. ADSL Annex M Standard and Business is designed to provide higher upstream bandwidth for those businesses which need to send larger amounts of data. It allows up to 16Mb downstream and 2.5Mb upstream, i.e. it can provide significantly more upstream performance than conventional ADSL2+ at a small cost to downstream bandwidth. ADSL Annex M Standard is only available via LLU, not via BTW. ADSL Annex M Premium is similar to ADSL Annex M Standard/Business but in addition to offering bandwidth of up to 16Mb down and 2.5Mb upstream it also offers a guarantee of 1Mb minimum throughout (both up and down) with guarantees covering latency, packet-loss and jitter thereby making it suitable for real time applications such as VoIP. Variable Speed It is important to note that these are maximum speeds and are very dependent on distance and line quality, with a rapid decrease in speed as the distance to the exchange increases. In addition the speed achieved may be liable to change over time if line quality improves or deteriorates. Most users will not be able to achieve the speeds mentioned above as you need to be within 500m of your telephone exchange using perfect cable. Some users may find their speed is no better than was available using standard ADSL MAX, and in very rare instances may even be reduced when compared to fixed bandwidth ADSL. Due to this variable line speed our charges for ADSL2+ Standard and Premium are identical to ADSL Max. First 10 days: Training period Note that the circuit trains itself in the first 10 days to support the fastest possible reliable bandwidth. During this time, speeds will vary and the router may need to be rebooted at times. When the service is first connected the line will be monitored and set at a speed which will be sustainable, called the stable line rate. Until this is completed we will not be able to tell you what speed you will actually receive. The line is constantly monitored and if there are any errors the line speed will be adjusted at a lower speed (this is referred to as a ‘retrain’). If a fault occurs this may mean that your internet connection retrains to a much lower speed, rather than stopping entirely. If your line speeds drops below a certain level compared to the Stable Line Rate we are able to report a fault through to our wholesale providers. LONDON: THE PRINTWORKS, 139 CLAPHAM ROAD, LONDON, SW9 0HP * TEL: 020 7501 3150 * FAX: 020 7501 3151 MIDLANDS: 40 THE BUSINESS CENTRE, EDWARD STREET, REDDITCH, B97 6HA * TEL: 0121 348 7700 * FAX: 0121 348 7701 Page 7 of 12 BACK UP CIRCUIT Supplementary Information Spitfire highly recommends a back-up ADSL circuit to help ensure that you have Internet connectivity should your primary circuit fail. We are currently offering free ADSL back-up on all 24 month contracts with ADSL Premium or Annex M circuits. Please contact us if you would like to take up this option to obtain the correct order form. A2. CHARGEABLE ADSL BACK UP CIRCUIT - 12 MONTH CONTRACTS Please tick option required Backup ADSL Connection: £50.00 Monthly Rental: £7.00 Backup ADSL Connection: £50.00 Monthly Rental: £10.00 (ADSL 2+ STANDARD) (ADSL 2+ PREMIUM) Access Network (To be completed by BTW TTB Spitfire) Do you require Spitfire to provide a manual changeover Technicolor router (£29.00)? Please note we will normally order the back up circuit on a different access network to the primary circuit if possible. Yes / No IMPORTANT INFORMATION REGARDING ALL BACK-UP CIRCUITS In the event that your primary (main) Broadband circuit experiences a fault, your internet connection will not automatically fail-over to the back-up circuit. It is the responsibility of the users on-site to disconnect the primary router and connect the back-up router; please ensure that a nominated person has been instructed in this change-over procedure. The routers connected to the primary and back-up circuits have the same IP address; this means that your LAN does not require re-configuration on fail-over. In order to avoid IP conflict, the router connected to the back-up ADSL circuit must not be plugged into the ADSL filter/telephone socket whilst the primary ADSL circuit is in service. If you wish to plug-in the back-up router to the telephone socket the power must be switched off. The discounted Back Up Circuit price is only available in conjunction with a Spitfire full price Primary Circuit. If the Primary circuit is ceased at any stage, the corresponding Back up circuit will also be ceased unless the customer requests the Back up circuit is upgraded to a normal circuit. If the customer requests a back up circuit is upgraded, standard circuit pricing will apply and a new contract will incept. New contract terms will apply except there will be no connection charges and a new minimum period of 1 month will apply. Please note on the bill the free back up circuit will be charged at the normal price for a standard circuit (£29.00 per month for ADSL2+ Standard) with a balancing credit to bring the cost down to zero. If power to both routers is ‘on’ and both routers are connected to their respective ADSL circuits you will lose connectivity. A3. TOTAL CARE - £9.20 per month Which Care Level do you require on the ADSL circuit? Standard Care - 40 Clock Hour target clear time. Please Circle your chosen Care Level Total Care - 20 Clock Hour target clear time. Standard Care - £0.00 Total Care Plus - 7 Clock Hour target clear time. Total Care requires 24/7 customer contact and site access. Please provide an out of hours contact name and number. Please note if you don’t select a Care Level Standard Care will automatically be applied. We will use the same contact details as indicated under the previous total care section. Total Care - £9.20 Total Care Plus - £11.50 A4. TELEPHONE LINE FOR BACK UP CIRCUIT LONDON: THE PRINTWORKS, 139 CLAPHAM ROAD, LONDON, SW9 0HP * TEL: 020 7501 3150 * FAX: 020 7501 3151 MIDLANDS: 40 THE BUSINESS CENTRE, EDWARD STREET, REDDITCH, B97 6HA * TEL: 0121 348 7700 * FAX: 0121 348 7701 Page 8 of 12 Existing BT analogue line number to be used for ADSL: This line must be a single analogue BT line (not part of a multi line group), presented on a standard BT socket: Would you like Spitfire to take over this phone line? This ensures top level support & faster faults diagnostics. Tel No: Yes / No Standard line rental is £10.00 plus £1.50 for Service Level 2 per month Do you need a new analogue line installed for your ADSL? Spitfire will order the analogue line and ADSL as a simultaneous provide which should mean that the ADSL will be live on the day that the line is installed. Simultaneous provides have an approximate 90% success rate, but if they fail, the ADSL will normally be live 7 working days after the line has been installed. Missed Appointments are charged at £100.00. Spitfire must give Openreach 48 hours notice or more when changing or cancelling appointments. Yes / No Installation: £99.00 Standard line rental is £10.00 plus £1.50 for Service Level 2 per month Service Level Options (Service Level governs the response time/ target repair time on your line- See Spitfire’s Service Level Agreement for further details). Target repair times are detailed below: Service Level 1: End of Next Working Day plus an additional Working Day, Monday to Friday excluding Public and Bank Holidays. PLEASE NOTE WE STRONGLY RECOMMEND SERVICE LEVEL 2 OR BETTER FOR BUSINESS USE. Service Level 2: End of Next Working Day, Monday to Saturday excluding Public Please Circle your chosen Service Level if you do not require Service Level 2 SL1 - £0.00 per Month and Bank Holidays. This is the default unless otherwise indicated SL3 - £4.50 per Month Service Level 3: End of Next Half Working, Monday to Sunday including Public SL4 - £5.50 per Month Holidays. Please note engineers only work 0700 hrs to 2100 hrs Service Level 4: Clear within 6 hours, any time of day, any day of the year. Please note if Openreach cannot gain access to site out of hours Service Level will reduce to SL1. MIGRATION ‘MAC’ CODE If you are Migrating your existing ADSL please obtain this from your existing ISP: LONDON: THE PRINTWORKS, 139 CLAPHAM ROAD, LONDON, SW9 0HP * TEL: 020 7501 3150 * FAX: 020 7501 3151 MIDLANDS: 40 THE BUSINESS CENTRE, EDWARD STREET, REDDITCH, B97 6HA * TEL: 0121 348 7700 * FAX: 0121 348 7701 Page 9 of 12 DOMAIN, EMAIL & WEB Supplementary Information B1. DOMAIN NAMES One off charges: Managed domain name registration: £50.00 for .com domains & £25.00 for .co.uk domains. (Registration fees apply for 2 years). Managed domain name transfer: £50.00 Monthly Rental: £2.00 per domain pm. Would you like Spitfire to host your Domain name(s)? Yes / No Please note that you will be sent a renewal notice by your International Registrar for any international domain (i.e. .coms) two years after registration. If you wish to keep the domain(s), you must pay them directly. We will continue to host the domains & provide any associated services. Domain/s to be transferred: Domain/s to be registered: Spitfire recommends that domain names are transferred or registered after a DSL has been migrated or connected. If commencement of a domain transfer or registration is required to start immediately, please tick your requirement below: PLEASE TRANSFER OR REGISTER OUR DOMAIN NAME ASAP PLEASE WAIT UNTIL ADSL CONNECTED / MIGRATED NB Not all ISPs will allow you to transfer your domain name and some may charge you to transfer a domain name to another Internet Service Provider. B2. E-MAIL Please tick which option is required: POP3/IMAP (Please list below) 50p per mail box per month SMTP (please advise IP address if known) £5.00 per month N/a If POP3 E-Mail Please list required addresses, i.e. bob@yourdomain.com or bob@spitfireuk.net B3. ANTI-VIRUS AND SPAM FILTERING Please tick the relevant box if you require our Spam Filtering Service and/or Anti-Virus service: Type of Filtering SMTP Mail Feed POP3/IMAP – per mailbox Spam Filtering £5.00 per month 50p per month Anti-Virus and Spam Filtering Up to 20 users: £25.00 per month Up to 50 users: £50.00 per month £2.00 per month LONDON: THE PRINTWORKS, 139 CLAPHAM ROAD, LONDON, SW9 0HP * TEL: 020 7501 3150 * FAX: 020 7501 3151 MIDLANDS: 40 THE BUSINESS CENTRE, EDWARD STREET, REDDITCH, B97 6HA * TEL: 0121 348 7700 * FAX: 0121 348 7701 Page 10 of 12 B4. WEBSITE DETAILS (PLEASE SELECT ONE OF THE FOLLOWING) Do you have a website? Would you like Spitfire to host your website? £5.00 per 50 MB pm. £1.00 per additional 10MB required pm? Yes / No Yes / No If web site is hosted elsewhere please provide either an IP address or a hostname for the site: B5. REGISTRANT DETAILS FOR DOMAIN TRANSFERS Where the registrant / current domain host contact details differ from those of the customer, please confirm the following: Name of Company who own and host the domain: Company Contact: Contact Tel. No: Contact Fax No: Contact Email Address: Name of Current ISP (if known): User name & password for ISP hosting the domain – e.g. control panel access (if known): LONDON: THE PRINTWORKS, 139 CLAPHAM ROAD, LONDON, SW9 0HP * TEL: 020 7501 3150 * FAX: 020 7501 3151 MIDLANDS: 40 THE BUSINESS CENTRE, EDWARD STREET, REDDITCH, B97 6HA * TEL: 0121 348 7700 * FAX: 0121 348 7701 Page 11 of 12 LONDON: THE PRINTWORKS, 139 CLAPHAM ROAD, LONDON, SW9 0HP * TEL: 020 7501 3150 * FAX: 020 7501 3151 MIDLANDS: 40 THE BUSINESS CENTRE, EDWARD STREET, REDDITCH, B97 6HA * TEL: 0121 348 7700 * FAX: 0121 348 7701 Page 12 of 12