Customer order details
Do you have a BT line* YesNo
What type of BT line do you have*
Standard Residential Line
ISDN2/Business/Home Highway
New Line Required
Are you an existing BT Openworld Customer?* YesNo
If YES enter in existing email address
Do you wish to also order a new telephone line simultaneously with BT Broadband? YesNo
If you already have a BT phone line please enter the number which you would like upgraded to Broadband
(Please include area code)

Migration
Do you wish to migrate to BT Broadband from another Internet Service Provider?* YesNo

Product details
Contract Type*
Standard Contract
2 Year Contract
(10% Discount)
1 Year Resign Contract
Which product does the customer wish to order*

Preferred installation / Activation date
ASAP
Selected Date Below
 

Customer name & Installation details
BT will contact you for payment details

Please state company name and address if different to customer installation name and address.
Title*
First Name*
Last Name*
Company Name*
Address Line 1*
Address Line 2*
Address Line 3
City
County
Post Code*
Main contact number*
Your job role*
Email address for order confirmation*

Customer billing details
Address Line 1
Address Line 2
Address Line 3
City / Town
County
Post Code
Customer billing contact*

Please confirm that you accept the BT Terms and Conditions and Privacy Policy for the service.*  
Please untick this box if you would not like to receive updates and special offers on BT related services.  
Please untick this box if you would not like to receive updates and special offers on business related services  

Registration details (You will need a user name and password to log on for email
Your preferred choice of name*
Your preferred choice of password is*
Password must be between 8-16 characters long and include at least 1 number. It should have no spaces or punctuation.

Security question
What is your mothers maiden name?
OR, What is your fathers date of birth?
OR, other question
Answer
Additional comments


* fields are mandatory




Harvey House, St Edwards Court, Romford, Essex, RM7 9QD
Registered address: 46-54 High Street, Ingatestone, Essex CM4 9DW