Customer Details:
Forename:       Surname: 
Company Name: 
Address:      
              
Phone:         Mobile: 
Email:        

I hereby authorise Munster Wireless Ltd. to install and activate the following
sevices. I have read and accept the Terms and Conditions of service.

		 Light Broadband	(€:25·00 pm)
		 Home Broadband	(€:35·00 pm) (recomended)
		 Business Broadband	(€:60·00 pm)

          Installation:      €:100·00 (payable on installation)

Signature:        Date: 

Standing Order:
To the Manager
Bank:         
Address:      
              
I/we hereby authorise and request you to debit my/our
Account Type:       
Name/Account Title: 
BIC:            
IBAN:           
with the sum of:
(please tick one)	 €:25·00 (light) Twenty Five euros
			 €:35·00 (home) Thirty Five euros
			 €:60·00 (business) Sixty euros
and to credit:      Munster Wireless Ltd.
BIC:                ULSBIE2DXXX
IBAN:               IE60ULSB98546510046035
Bank:               Ulster Bank, 19 O'Connell St., Clonmel, Co. Tipperary.
on the  5th  15th  25th day of each month
Start date:  Until further notice in writing.

Narrative (office use only):  -  - 

It shall be understood that the Bank shall not be under any liability
for damage or loss caused by any omission to make these payments.
Please allow 5 working days notice prior to first payment.

Signature:     Date: