CityLink Application form : ExchangeNET Peering Point (including IPv4 & IPv6 : Products & Services

I (the reader and duly authorised person) hereby apply for the supply of a network connection and services in accordance with CityLink's standard terms and conditions. I declare that I know of no debt owing to CityLink in respect of previous failure to pay and I agree to pay for all services and connections as set out in the Supply Agreement. I agree to give at least one month notice of intention to vacate, disconnect or reconnect the premises or services.

Installation and monthly fees will be confirmed by CityLink on receipt of this form.

Application form

Required fields are labelled as (required).

Full company Name: (required) Trading Name: (required) Client Order Number: (required) Building name: (required) Floor no.: (required) Street no.: (required) Street name: (required) City: (required) Service Requirement Date: (required)

Do you already have a CityLink connection at this location?:

Tick if YES

Name of company arranging service if other than actual client company: What is the company's main business activity?:

Contact Person for this Order Contact Person Name: (required) Contact Person Phone: (required) Contact Person Email: (required)

Invoicing contact details Company name: (required) Contact person: (required) Company position: (required) Invoice postal address: (required) Billing contact phone: (required) Billing contact fax: Billing contact email: (required)

Exchange Point

Exchange point: (required)

Do you have an existing connection to the Exchange: (required)

If yes what is the service ID:

Service Required

Service required: (required)

25
100
1000

Protocol required: (required)

IPv4
IPv6

Contract term

Contract terms:

24 months
36 months

Comments:

Technical contact details Technical contact name: (required) Position: (required) Technical contact phone: (required) Technical contact fax: Technical contact email: (required)

Peering Details - IPv4 AS Number (We can help you obtain an AS Number if you need one): IPv4 networks to be advertised: Proposed router
(Make, model, software version):

Peering Details - IPv6 AS Number (We can help you obtain an AS Number if you need one): IPv6 networks to be advertised: Proposed router
(Make, model, software version):

Services order agreement

I hereby order the services I have indicated above and agree to abide by the CityLink Standard Terms and Conditions

Name: (required) Position: (required) Date: (required)

Email: (required)
CAPTCHA Image

Reload Image Enter image text in the box below: (required)

Last updated 16/03/09 | Created 14/08/2007

ExchangeNET Peering Point (including IPv4 & IPv6)

Contract for supply