| 1. Application details (complete A or B below) |
| A - Personal account details |
| Personal account name | |
| Personal account number | |
| Contact name | |
| Email Address | |
| Mobile number (you will be contacted by text when your sevice is connected/upgraded) | |
| 2. Service details |
| Broadband telephone number you wish to upgrade | |
Tick Broadband options required in ‘a’ to ‘g’ below.
(please refer to our Internet Connection Guide or our Website for further information and charges) |
| A - Tariff option (should your chosen speed not be attainable on your line we will provide you with the closest tariff on the same contract terms. Please note if you select an 18 month contract you broadband line rental will be half price for the first 3 months) |
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| B - Contract term |
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| C - Modem option (Up to 8 Meg Home service requires an ADSL2+ compatible modem / router. Please refer to the compatability list for details) |
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| D - Install option (If you are upgrading your broadband service please skip this section and move to section F) |
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| Adaptors for Wireless Modem option: | |
| For details on wireless adaptors please visit the Jersey Telecom shop. |
| E - Computer |
| What computer are you using? | |
| F - Is your home broadband connection used for any of the following? |
| Downloading music / movies (e.g. iTunes, Amazon) | |
| Streaming Radio | |
| Streaming / Downloading TV Programmes (e.g. BBC iPlayer) | |
| Online Gaming | |
| G - Online billing |
| In order to view broadband usage, you must be signed up to the Jersey Telecom online billing portal. (Please note if you sign up the portal you will still receive paper bills, however you can switch to paperless billing once registered) |
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| 3. Important information |
| This Application forms part of the Jersey Telecom Data Services Terms and Conditions (“Terms and Conditions”) under which we will provide the Rapid broadband Service. A copy of the Terms and Conditions can be downloaded here. You should read the Terms and Conditions carefully and only submit this form if they are acceptable to you. Data collected on this form will be used to enable us to process your order and will only be disclosed to those bodies or authorities which have been identified within Jersey Telecom’s registrations under the Data Protection (Jersey) Law 2005 and any amendments to this Law. We will also use this data to keep you updated with news about our products and services. All prices exclude GST which will be added at time of billing. |
| 4. Declaration |
| I am / we are at least 18 years of age and make this Application having understood all applicable Terms and conditions and Service Charges concerning this Contract. I / we understand and agree that I/we will be responsible for all Charges as applicable for a Minimum Contract Period of twelve or eighteen months unless I/we are taking over the Service(s) without break from another customer where the remainder of any applicable twelve month Minimum Contract Period will apply. |
| 4a. Agreement |
| Please tick here if you have read the important information and agree to the declaration section above. | |
| 4b. Applicant's details |
| Name | |
| Date | |
| 5. Submit (please press the button below to apply for Broadband) |
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| Please only press button once, you will see a confirmation when your application has been submitted. |