Customer Details

* First Name

* Last Name

* Company Name

* Position

* Street Address

Address Line 2

* City

* County

* Post Code

* Phone Number

Alternate Number

Mobile Number

Fax Number

* Email Address

Free Non Geographic Number Order Section

You can have up to three (3) NGN numbers for absolutely free.

Which NGN do you require

Quantity

Number to Re-Direct to

Which NGN do you require

Quantity

Number to Re-Direct to

Which NGN do you require

Quantity

Number to Re-Direct to

_________________________________________________________________________

You can of course, have more than three Non Geographic Numbers supplied free of charge if you purchase AdTracker for £50pa +vat. This can be done using the boxes below and the AdTracker selection in the next section.

IMPORTANT - This form is not valid for those requiring a NGN number that will terminate on either a mobile phone or a VOIP Number. For these services you must download the appropriate form from above, fill it in and sign it. Without a signature we cannot process your request.

Which NGN do you require

Quantity

Number to Re-Direct to

Adtracker

Yes

Popular Other Services Order Section

AGM|Adtracker - £50pa +vat

Select

Yes

How many numbers are you thinking of having

AGM|Customer Controlled Routing - £30pa +vat

Select

Yes

How many?

NGN Number

Existing NGN Number

Re-Direction Numbers

AGM|Voice Mail - £30pa +vat

Select

Yes

NGN Number

Existing NGN Number

Email to pass notifications on to

AGM|Number Divert - £30pa +vat

Select

Yes

NGN Number

Existing NGN Number

Number to divert to

AGM|Fax to Email - £50pa +vat

Select

Yes

NGN Number

Existing NGN Number

Email for faxes to go to

AGM|Email to Fax - £50pa +vat

Select

Yes

Email address for faxes

AGM|Dialed Number Display - £30pa +vat

Select

Yes

NGN Number

AGM|CLI/0845 Delivery - £50pa +vat

Select

Yes

NGN Number

Any Other Queries

Enter your question or orders that are outside of the services shown above

Other Information

Receive Mass Email?

Is it ok for us to send you information and offers via email now and again?

Agree to Terms & Conditions

Terms & Conditions

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New Users / Returning Users CLICK HERE to setup or return to your account for this form. Creating an account enables you to return to this form and your submitted results. An account will also enable you to partially complete this form and return later to finish the form. The account you establish is only for this form.

Dealer Code - 1150

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