Dart Telecom

New Customer Order Form

â† darttelecom.com

Dart Telecom - Order Form

1. Contact Information

First Name*

Last Name*

Email Address*

Mobile Number 1*

SMS Notifications 1*

Mobile Number 2

SMS Notifications 2

Property Type*

Master Socket (Internal)

Preferred Communication Method (Check all that apply)

Email SMS Post Monthly Post Quarterly

2. Installation Address

Current Address*

Current Postcode*

City*

Installation Site

Preferred Engineer Time Slot

AM (8amâ€“1pm) PM (1pmâ€“6pm)

3. Line Transfer & Porting

Number Requirement

Number to Port (Existing Landline)

Previous Provider *

4. Plan & Hardware

Monthly Package*

Hardware Selection*

Preferred Monthly Payment Date If chosen date doesn't exist in a month, payment collects on the last day.

5. Payment Details

Initial Payment

Initial Payment: Â£25.00 â€” one-off flat fee

How would you like to pay?

ðŸ’³ Card via Stripe

Pay initial payment now; set up BACS direct debit for monthly billing

ðŸ¦ BACS via Stripe

One BACS mandate covers initial payment, first bill & recurring monthly

âš ï¸ Please note: Payments are processed securely through Stripe. Transactions will appear on your bank statement as "Stripe", with "Dart" in the reference.

I agree to the terms and conditions. Dart Telecom reserves the right to increase prices if need be. We will give a Month prior notice in the event this change is being made. We are still new, and we very much request you report any failures or any issues that may occur and we will do our best to put it right.

By providing your bank account details and confirming this, you are agreeing to the Direct Debit Guarantee and authorizing Dart Telecom to take payments via BACS for the initial payment and monthly recurring subscriptions as summarized above.

Dart Telecom

Order Confirmed!

Dart Telecom - Order Form