Akiva Voice & Broadband Enquiry Form

First Name

Surname

Company Name (if applicable)

Email Address

Phone Number

Site Address (For Installation)

If you are enquiring about broadband, please choose a Plan from the following options. If you are enquiring about broadband, please choose a Plan from the following options. Totara (100/100 Unlimited) Rimu (200/200 Unlimited) Rata (MAX/500 Unlimited) Not Applicable

Do you have an existing Fibre connection? Do you have an existing Fibre connection? Yes No

If you selected YES, please tell us who that provider is. If you selected YES, please tell us who that provider is. Vodafone Spark MyRepublic 2degrees Other

If you selected Other, please tell us who that provider is.

Do you need a router? Do you need a router? Yes, I would like a router supplied? No, I will supply my own router

Do you wish to purchase the router outright or rent it on a monthly basis? Do you wish to purchase the router outright or rent it on a monthly basis? Purchase outright Rent on a monthly basis

Would you like the router preconfigured for online gaming? Would you like the router preconfigured for online gaming? Yes No, standard configuration is fine

Please select your preferred gaming platform. Please select your preferred gaming platform. Xbox Playstation

If you are enquiring about SIP services, please choose a Plan from the following options. If you are enquiring about SIP services, please choose a Plan from the following options. Kea - (Essential) Kiwi - (SOHO) Kereru - (Business) Kakapo - (Custom) NOT APPLICABLE

If you selected the Kakapo plan, please give us a brief outline on what your specific requirements are, ie line numbers, mobile minute requirements, etc.

Please tell us the Urgency Level For Contacting you Please tell us the Urgency Level For Contacting youAbsolutely desperate for the work immediately!Starting to go crazy - pulling my hair out!Chillaxed and can wait my turn!

Please let us know if you have any special requirements for service or if you have issues like poor wireless coverage.