Information for connecting to the cablecom multimedia network

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Constructor (Contract partner)

Enterprise:

First Name: *

Last Name: *

Address: *

ZIP, City: *

Phone Privat: **

Phone Work: **

** It is necessary to enter at least one telephone number.

Fax:

E-Mail: *

Location

Address: *

ZIP, City: *

New allotment number: **

Old allotment number: **

** It is necessary to enter at least one of the two allotment numbers.

Building project

Please choose: *

Other:

Amount (please fill in at least on field.)

Buildings: *

Appartments: *

Separate rooms: *

Shops: *

Offices: *

Number of the wished tv-sockets

Internal annotations:

Start of construction: *

Designated reference date: *

Architect

Electric installation

>Installation enterprise

Other contact points and persons

Notes:

The owner chooses the following services by upc cablecom*

Domestic connection without home provisioning equipment installation through upc cablecom Service Plus (recommended for multimedia applications) Domestic connection with home provisioning equipment installation through upc cablecom Service Plus (recommended for multimedia applications) For business premises, hospitals, nursery homes, schools, hotels, hotel-style accommodation, institutions, homes, industrial enterprises and factories standard domestic connection (signal only)

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Information for connecting to the cablecom multimedia network

Constructor (Contract partner)

Location

Building project

Amount (please fill in at least on field.)

Attachment