RESIDENTIAL FIXED LINE SERVICE REQUEST FORM


Service Detail:

Service Request Type*
Service Type *
Service Number*
Consolidated/Existing Account Number
Address Information: New Address Information:
Region* New Region*
Zone/Sub city/Main city* NewZone/Sub city/Main city*
Woreda* New Woreda*
Kebele NewKebele
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:

*