Title * :
First Name * :
Last Name * :
Address * :
 
Postcode * :
Town * :
Country * :
Telephone * :
Mobile :
Email * :
Where did you hear about us ? :
Comment :

   Line Installation :
   Have you ever been registered with
   France Telecom ?
   Previous Phone Number:
   Profession:
   Property Type:
   House or Flat Number:
   Floor:
   Previous Line owner's name and phone number:
   Neighbour's Name:
   Neighbour's Phone Number:
   Do you own the property:
   Do you rent the property:
   Is it a newly built property ?:
   if yes are there sockets in the house ?
   Desired activation date:
   Line Rental :
   Free Options :  Number permanently withheld on the landline Free UKDirect2u Number Register in French Directory
   Landline Calling Features :  Call Waiting (1€/month)  Transfer of Calls (1€/month) Message Service (Answerphone) (1€/month)
   Before your application will be processed please download, print or scan the Direct Debit mandate.
   UK Direct Debit Form or French Prelevement Form
   Please fill the form in carefully and sign it before e-mailing or posting it to us at :
   enquiries@uktelecom.uk.net
   or
   UKTelecom Ltd. William House, 45 Bury Fields, Guildford, GU2 4AZ, United Kingdom
   N.B. Please note that your passport copy and a French R.I.B. bank slip are required when we liaise with France Telecom to activate
   your telephone line.
   Your application cannot be processed before this documentation reaches us by e-mail, fax or post.

 I confirm that I agree to send you a copy of my passport and a French R.I.B. bank slip and accept the         terms and conditions

* Required
** Default