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Please fill in and submit the form opposite.
As soon as we receive your form, somebody will call you and arrange for an on site engineer to visit.
Alternatively call us on 0116 22346 to arrange a visit.
Name
Email address
Telephone number
Address
Broadband connection? Cable - NTL / Virgin Media ADSL Phone Line (BT, AOL, Tiscali etc.) Satellite None
Username and password for the internet connection (not required for Virgin Media / NTL Cable customers.)
Windows Version of main PC? Windows 95 Windows 98 Windows 98SE Windows ME Windows 2000 Windows XP Home SP1 Windows XP Home SP2 Windows XP Pro SP1 Windows XP Pro SP2 Windows Media Centre Windows Vista Home Basic Windows Vista Home Premium Windows Vista Business Windows Vista Ultimate Windows NT Windows Server 2000 Windows Small Business Server 2000 Windows Server 2003 Windows Small Business Server 2003
Do you already have a wireless modem / router? No Yes Dont Know
If you do, what is the make and model of the router?
Number of computers 3 or less 4 - 6 7 -10 10 - 15 15 - 20 more than 20 devices
Date visit required