MODEM - WIFI ROUTER | EQUIPMENTS BRAVO TELECOM

Residential Telecommunication Services - Relocation Form

First name *

Last name *

Account number

Phone number (Main) *

Phone number (Secondary) *

Email *

Civic number *

Street *

App#

City *

Postal code *

Please select one of the following elements * I‘m moving out AND I want to take advantage of the promotionI’m NOT moving out BUT I want to take advantage of the promotion

Civic number

Street

App#

City

Postal code

Date *

Time frame * Morning (7h30AM-Noon)Afternoon (Noon-5h00PM)Evening (5h00PM-9h00PM)Entire day (7h30AM-9h00PM)

Date *

Time frame * Morning (7h30AM-Noon)Afternoon (Noon-5h00PM)Evening (5h00PM-9h00PM)Entire day (7h30AM-9h00PM)

Date *

Time frame * Morning (7h30AM-Noon)Afternoon (Noon-5h00PM)Evening (5h00PM-9h00PM)Entire day (7h30AM-9h00PM)

Current package *

New package Internet cable 5M unlimitedInternet hybrid fiber 15M unlimitedInternet hybrid fiber 30M unlimitedInternet hybrid fiber 60M unlimitedDUO cable 5M unlimitedDUO hybrid fiber 15M unlimitedDUO hybrid fiber 30M unlimitedDUO hybrid fiber 60M unlimitedBundle cable 5M unlimitedBundle hybrid fiber 15M unlimitedBundle hybrid fiber 30M unlimitedBundle hybrid fiber 60M unlimited

Monthly subscription (month)

Half-Annual subscription (6 months)

Annual subscription (12 months)

Shipping * Pickup (free)Postal delivery ($10)Full installation ($30)

I agree to pay 69.90$ +tx to enjoy my new service plan, plus shipping, if applicable. *

0 + 1 = ? Please prove that you are human by solving the equation *