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Digi Service Request Form 2023 Updated

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GARIKAI KATSERE
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72 views

Digi Service Request Form 2023 Updated

Uploaded by

GARIKAI KATSERE
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DIGI SERVICE REQUEST FORM

CUSTOMER INFORMATION:

NAME:
DATE: TYPE: ☐ New Customer ☐ Upgrade
MASTER ACCOUNT #: OBJECT ID:
ID NUMBER: MOBILE CONTACT NUMBER:
STREET ADDRESS: ADDITIONAL CONTACT #:
CITY/TOWN/VILLAGE: EMAIL ADDRESS:
DISTRICT: FULFILLMENT#:

LOCATION DESCRIPTION: _______________________________________________________

Requested Plan
Promotional Plans
Plan Monthly Speed (UL/DL) Paired Number DigiTV User (email
Fee* (Mobile) address)
☐ DigiEntry $49 20Mbps/10Mbps Not Applicable
☐ DigiONE Starter $79 30Mbps/15Mbps Not Applicable
☐ DigiONE Essential $109 80Mbps/40Mbps Not Applicable
☐ DigiONE Premium $139 120Mbps/60Mbps
☐ DigiONE Elite $219 200Mbps/100Mbps
DigiBoost Plans
☐ Boost DigiBasic $79 40Mbps/20Mbps Not Applicable
☐ Boost DigiDouble $119 80Mbps/40Mbps
☐ Boost DigiTriple $199 150Mbps/75Mbps
☐ Static IP $5 Not Applicable Not Applicable
* Monthly Fee Inclusive of Tax & Modem Rental

PROMOTIONAL OFFER:_____________________________ ☐Free Installation ☐ No Deposit


By completing and submitting this Service Request Form I accept the Service and agree to be
bound by all Belize Telemedia Limited (“BTL”) Terms and Conditions as amended from time to
time including; the terms and conditions located at https://www.livedigi.com/terms-and-
conditions , the General Terms and Conditions found in the Belize Telemedia Limited Telephone
Directory, and all other terms as may be applicable to the Service. Upon signing this document, I
am deemed to have read, understood, and accepted the said applicable Terms and Conditions
which are available upon request.
Customer Signature: Digi Rep Signature:

Customer Name: Digi Rep Name

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