APPLICATION FORM
Dial-up and Residential ADSL

1. Please tick the appropriate boxes for the services or goods you require:

 

Dial-Up

[ ]

Dial-up Pay as You Go, paid through telephone charge. Available 6pm-8am Monday-Friday, Bank holidays and all weekends.

[ ]

Standard Dial-up (ฃ96 annually + VAT = ฃ112.80).

 

Broadband/ADSL

[ ]

Residential ADSL  (ฃ132 annually + VAT = ฃ155.10)

Up to *2Mbps downstream and 256Kbps upstream, contended 50:1

(provided on a best efforts basis – depends on distance to exchange).

(MT Charge ฃ13/month + VAT = ฃ15.27)

 

[ ] Wireless 4-port Router

[ ] Other    please specifiy __________________________________________________

 

 

Install ADSL on which telephone number              01624-_______________

 

Name under which line  registered __________________________________

 

 

Please specify primary e-mail address____________________@mcb.net

 

Please specify a password                   ____________________

 

All services include one e-mail address with unlimited mail size, unlimited personal web space (unsupported), e-mail anti-virus scanner and other services.

            Options

[ ]

Unmetered dial-up (free from telephone charges) access. Payment to Manx Telecom of ฃ6.10/month + VAT (ฃ15/month + VAT for a business line) and you need to register your telephone number with Manx Telecom. Follow link from www.mcb.net -> Download Forms

[ ]

Fixed IP address (currently only available on dial-up connections)

[ ]

Provide DNS entry for direct SMTP to your computer (requires Fixed IP address)

[ ]

Additional POP3 mail addresses (ฃ5/address/year + VAT = ฃ5.87)

_________________________________________

[ ]

Anti-SPAM/Anti-Virus filter (ฃ10/year/address + VAT = ฃ11.75)


2. Please indicate your method of payment:

[ ]

Cheque enclosed for _________________

[ ]

Quarterly payment option for personal users. Please fill in standing order form below (include handling charge of ฃ8/year + VAT = ฃ9.40)

[ ]

Please charge to Visa/Mastercard/Switch Number:

 

______________________________ 

 

 

Expiry date: ______________

 

Signature: ___________________________________

 

 

[ ]

Please indicate if you are an existing or new customer paying by standing order. If so please fill out the standing order form below and RETURN IT TO US for forwarding to your bank.

It is understood that you are subscribing to MCB on an on-going basis for a minimum period of 12 months. Manx Computer Bureau will keep your account open and charge you appropriately until you notify us in writing that you wish to cancel. VAT invoices will be issued annually. The MCB Subscription service is provided, and must be used by subscribers, in accordance with the Isle of Man communications legislation and is subject to the Data Protection Act 2002. All users are advised to familiarize themselves with such legislation and Manx Computer Bureau reserves the right to withdraw service in the event that a subscriber is proved to be in breach of Manx law.

3. Your Details

Your Name:

 

Company: (optional)

 

Address:

 

*Telephone: (home/office)

 

Fax:

 

Signed:

 

Date:

 

* For ADSL please indicate if the telephone number is used for the ADSL line. If not, please indicate which telephone number the ADSL is to be installed on.

 

4. Billing Information (if different from above)

Your Name:

 

Company: (optional)

 

Address:

 

Telephone: (home/office)

 

Fax:

 

Signed:

 

Date:

 

Return completed application form to:

Manx Computer Bureau Ltd, M & G House, Head Road, Douglas IM1 5BF.

Tel: 01624 623841. Fax: 01624 623004. Email:admin@mcb.net


 

MCB.Net STANDING ORDER INSTRUCTION

 

Please  *overwrite any previous standing order/amend the existing standing order/

  accept this new standing order

(* delete as appropriate)

 

To the Manager of

……………………………..

Bank    /

Building Society

 

 

 

 

Branch

……………………………...

Sort Code

……………………….

 

 

 

 

Address

………………………………

………..

……………………….

 

 

 

 

Name of Account

………………………………

Account Number

……………………….

Reference to be quoted

………………………………

 

 

 

Please pay the sum of ฃ…………. on 1st / 15th of……………………. and every three months thereafter until notified by me in writing to:

 

Manx Computer Bureau Ltd,M&G House,Head Road,Douglas,Isle of Man,IM1 5BF

 

Lloyds Bank Ltd,Victory House,Prospect Hill,Douglas

Sort code:        30-12-80

A/C number    0281547

 

 

Signed …………………………………….  Date …/……/20.….