Está en la página 1de 1

application form

Welcome to Etisalat. New application Name of applicant company: C/O: Contact number: Administrative contact details: Building: Upgrade Downgrade

BusinessOne

Complete this form if you are applying for BusinessOne. Please note that incomplete details may cause delays in providing the service.

Company details for new customers


P.O.Box: Passport number: Floor/Flat No.: Emirate: Email: Technical contact details: Working No. in the same at:

For existing BusinessOne customers


BusinessOne account number: Company name:
(Tick Box) Limited BusinessOne

Contact number:
Unlimited BusinessOne

1. BusinessOne packages
Please choose your preferred package as Limited or Unlimited:
up to

16Mbps multi-user 8Mbps multi-user

16Mbps 8Mbps

2Mbps 1Mbps

180 100

6GB 5GB

180 100

2GB 2GB

30 25

4,850 3,550

5,250 4,200

*Standard monthly volume caps are applicable only for Limited packages.

** Usage exceeding the monthly data volume cap is charged at AED 50 per 500MB or part thereof.

2. Username
1st choice 2nd choice 3rd choice
Username should contain 2-8 characters (can be alphanumeric characters: A-Z or 0-9)

6. Optional services
Tick the boxes for your preference of optional services
Optional Services Additional Email Accounts (50MB storage) Additional Email Storage (50MB storage) Additional Email Storage (100MB storage) Additional Email Storage (200MB storage) Additional Email Storage (500MB storage) Additional Email Storage (1000MB storage) Additional Web Storage (20MB storage) Administrative Contact Additional Web Storage (50MB storage) Additional Web Storage (100MB storage) Additional Web Storage (200MB storage) Additional Web Storage (400MB storage) Additional Web Storage (600MB storage) Additional Web Storage (800MB storage) Additional Web Storage (1000MB storage) Monthly Charge AED 10 AED 6 AED 10 AED 18 AED 45 AED 80 AED 7 AED 15 AED 28 AED 54 AED 104 AED 150 AED 192 AED 230 Quantity

3. Domain name
1st choice: 2nd choice: 3rd choice:

Full Name: Job Title: Tel No.: Email Address:


Minimum period of hire for the domain is 1 year Domain name is renewed on yearly basis

4. Modem & Installation

Installation: AED 200 Please tick the box if you require a modem BusinessOne Modem: AED 300

7. Your authorisation
I/We hereby conrm to Etisalat that I/We have the authority and/or permission to install the Etisalat services in the abovementioned address and hereby agree to the Terms & Conditions" of Etisalat.

5. Bill statement
English Arabic Signature Date: _____________________ Company Stamp

8. Required documents For our use only


Request No.: Domain name: Card No. (Envelope No.): National number exchange: Surveyor Sig:

Visa and Passport copy of owner or sponsor Copy of valid Trade Licence & Power of Attorney Sub-Request No.: Surveyor information: Plot No.: Account No.: Username: Exchange: DP No.:

Sector No.: Cab No.:

También podría gustarte