RESIDENTIAL FIXED BROADBAND SERVICE REQUEST FORM


Service Detail:
Service Request Type *
Service Type*
Service Number *
Consolidated/Existing Account Number
Bandwidth Speed *
Address Information: New Address Information:
Region * New Region*
Zone/Sub city/Main City * NewZone/Sub city/Main City*
Woreda* New Woreda*
Kebele New Kebele
Building Name New Building Name
House Number New House Number
Specific Location New Specific Location

Contact Person:
First Name*
Middle Name*
Last Name*
Mobile Number *
Additional Contact Number
Email:

*