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FibreWire TV
AV Program
Customer Information
Do you have existing services with One Communication?
*
Yes - FibreWire Basic Bundle
Yes - FibreWire Better Bundle
Yes - FibreWire Best Bundle
Yes - FibreWire Ultimate Bundle
Yes - Holiday Bundle 1
Yes - Holiday Bundle 2
Yes - FibreWire Smart Internet - 200 Mbps
Yes - FibreWire Smart Internet - 300 Mbps
Yes - Holiday Internet Plan - 300 Mbps
Yes - FibreWire Smart Internet - 450 Mbps
Yes - Holiday Internet Plan - 500 Mbps
Yes - FibreWire Smart Internet - 600 Mbps
Yes - FibreWire Smart Internet - 750 Mbps
Yes - FibreWire Smart Interet - 1Gig
No
First Name
*
Last Name
*
Email Address
*
Phone Number
*
Home Phone (if different from above)
Work Phone
Address
*
One Communication Account Number
*
House Name
*
Street Number and Name
*
Parish
*
Devonshire
Hamilton
Paget
Pembroke
Sandys
Smith's
Southampton
St. George's
Warwick
Potal Code
*
General Directions to Your Home
House Colour
*
House Trim and/or Shutters Colour
*
Utility Room Location
*
Utility room requires landlord to be present and unlock?
*
Yes
No
Do you have a dog?
*
Yes
No
Hours of Availability for Home Installation
*
Other Instructions
NextOne TV Program
Please complete the below section if the you are purchasing a TV under the NextOne/NextOne Premium TV program.
NextOne Program Selected
*
NextOne - 24 Months
NextOne Premium - 36 Months
Make of TV
*
TV Model Number
*
TV Serial Number
*
Retail/Invoice Price of TV
*
Payment Made By Customer
*
Value Placed On NextOne/NextOne Premium Program
*
Audio Visual Invoice Number
*
Security Information
Date of Birth
*
MM slash DD slash YYYY
Identification Document
*
Driver's License Number
Passport Number
Identification Document Number
*
Product Subscription
Customer would like to subscribe to:
*
FibreWire Bundle with NextOne TV Program
FibreWire TV
FibreWire Internet
Select Bundle
*
FibreWire Basic Bundle - $200
FibreWire Better Bundle - $255
FibreWire Best Bundle - $310
FibreWire Ultimate Bundle - $365
Number of TVs
@ $12 per STB above the first Free STB
Select Premium Package
HBO - $16.20
Call Classic - $12
Flow Sport - $22
Cinemax - $13
TFC - $15
TMC - $12
Showtime - $13
Sportsmax - $22
RTP Pack - $7.50
Select TV Package
*
FibreWire TV Some - $30
FibreWire TV More - $62.50
FibreWire TV Most - $80.50
FibreWire TV Ultimate - $140
Number of TVs
@ $12 per STB above the first Free STB
Select cDVR Package
-Select-
cDVR 200 Hours - $10
cDVR 400 Hours - $20
cDVR 500 Hours - FREE with Ultimate Tier
Select Premium Package
HBO - $16.20
Call Classic - $12
Flow Sport - $22
Cinemax - $13
TFC - $15
TMC - $12
Showtime - $13
Sportsmax - $22
RTP Pack - $7.50
Select FibreWire Internet Plan
*
FibreWire 50 Mbps - $80
FibreWire 200 Mbps - $130
FibreWire 300 Mbps - $150
FibreWire 450 Mbps - $185
FibreWire 600 Mbps - $215
FibreWire 1Gig - $300
One Communication Customer Email Address
*
This email must end in @logic.bm
Select OneHome WiFi Package
-Select-
OneHome 2 Package - $14
OneHome 3 Package - $20
Monthly Customer Bill
Total Monthly Customer Bill
*
Customer Approval
Date
*
MM slash DD slash YYYY
Time of Submission
*
Customer Credit Checks
Date of BCA Check
Time of BCA Check
BCA Credit Rating
Select Credit Rating
Rating A
Rating B
Rating C
Rating N
Name of Customer on BCA Website
Audio Visual Information
Sales Associate Name
*
Sales Associate Employee Number
*
One Communications Rep Who Verified Plan
*