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ITC CUSTOMER REQUIREMENT FORM

Customer Details

Customer Details
Customer Name/Company *
Business Type
Representative *
Representative Designation
Address
Tel *
Fax
Rep Tel
Rep Email *

Service Details

Service Details
Required Capacity Rate (Mbps)
A-end Address
A-end Address
Circuit Protection Options Protected Partially Protected Unprotected
Service Period (mo) Year Month
Target RFS Date
Please mention any additional requirements or dependencies
 
 


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