Order – Community Action Suffolk IT Services

Title*

First Name*

Surname*

Address Line 1*

Address Line 2

Village

Town*

County*

Postcode*

Contact Telephone Number*

Telephone Number to Activate (if different from above)

Contact Email Address

Product

Price per month

Username/Suffolk Online Email Address Requested

@suffolkonline.net

Mmaximum 16 characters before @suffolkonline.net. Existing Customers please ignore this field

Set Password Existing Customers please ignore this field

Do you require a Direct Debit to be sent out to you?*

Additional microfilters Please note you receive 1 automatically with our broadband routers. Microfilters are charged at £4 each

Are you migrating from another supplier?*

If Yes then who is your Internet supplier you are migrating from?

Do you have any other questions?