Titanic Telecoms Network Services Agreement Contact Agreement 2025 Please Select Customer TypeMark ONE with an "X"ECAS: Existing Customer Additonal Services ECR: Existing Customer Renewal NC: New Customer Additional InformationTITA Document Please mark with "X" if applicableProvisioned Date Account No. Provisioned By Go Live Date Sales Agent Customer / Site DetailsTitle(Required) First Name(Required) Last Name(Required) Company Name(Required) Company type(Required) Date of Birth(Required) DD slash MM slash YYYY Address(Required) Postcode(Required) Company Number(Required) Email(Required) Mobile(Required) Tel Billing DetailsEmail Address Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Only If different to aboveEmail Invoice Please Tick Order Summary (Tariffs)(Required)Porting Number(Required) PAC Code(Required) Sim Serial Number(Required) Hardware(Required) Hardware Upfront Cost(Required)IMEI / Serial Contract Term (Months)(Required) Cost Per Month(Required)Spend Cap(Required) Order Summary (Tariffs)Porting Number PAC Code Sim Serial Number Hardware Hardware Upfront CostIMEI / Serial Contract Term (Months) Cost Per MonthSpend Cap Order Summary (Tariffs)Porting Number PAC Code Sim Serial Number Hardware Hardware Upfront CostIMEI / Serial Contract Term (Months) Cost Per MonthSpend Cap By signing this agreement you have read and agree to our standard terms and conditions of service. Total Monthly CostUpfront CostName(Required) First Date DD slash MM slash YYYY SignatureThis agreement constitutes a formal request ('offer') by the customer ('you') for Titanic Telecoms Ltd ('us') to provide services as detailed in this document. This offer is subject to status, and is subject to approval as our discretion. please note that the "signee" shall acknowledge full authority to sign on behalf of the business. All contracts are committed to, in full, any early termination of services will encounter an "early termination fee" which will be calculated by monthly fee and length remaining. If you have any questions or concerns regarding this contract, please contact Titanic Telecoms prior to signing this agreement. Titanic Telecoms Ltd (NI681039) Unit 29 - Kennedy Centre - Belfast - BT11 9AE - 02890 955 255 Δ
