Service Application Form

Please complete the form below. Fields marked * are mandatory.

About the Property

Apartment Number: *

Property Name: *

Address 1: *

Address 2:

Town/City: *

Postcode: *

About You:

Title:

First Name: *

Last Name: *

Email Address: *

Phone: *

Date of Birth: *

About Equipment:

Is there a router in your apartment?

Yes

We will send you a router on free loan.

Do you wish the router to be delivered to an alternative address?

Capacity requirements:

Please answer the following questions - they will help us in planning any future upgrades.

How many users are there in your apartment?

Approximately how many devices (phones, tablets, computers etc) are there in total?

Please choose the option that most closely matches your useage:

Contractual stuff:

Before you submit this form, you must agree to the following.

I am over the age of 18 and am the bill payer for the above property.
I have read, and agree to be bound by the terms and conditions of, the contract linked here
I understand that the contract I am entering into has a minimum period of twelve calendar months, and at the expiry of that period continues on a month by month basis until terminated by one full calendar months notice.
I agree that any notice given by myself in relation to this contract must be given in writing by letter or email and confirmed by TIA Broadband in writing.
I agree that the contract will begin from the first day of the month following confirmation that the service is live and operational in my premises.
I agree that by ticking the box below and clicking the submit button I am legally bound by the conditions above.

I agree to the conditions set out above *

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