NextOne TV Program

Customer Information
Do you have existing services with One Communication?*
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*
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 if the you are purchasing a TV under the Next One TV program.
Make of TV*
TV Model Number*
TV Serial Number*
Retail/Invoice Price of TV*
Payment Made By Customer*
Value Placed On Next One TV Program*
Sound Decision Invoice Number*
Security Information
Date of Birth*
MM slash DD slash YYYY
Identification Document*
Identification Document Number*
Product Subscription
Customer would like to subscribe to:*
Select Bundle*
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*
Number of TVs
@ $12 per STB above the first Free STB
Select cDVR Package
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*
One Communication Customer Email Address*
This email must end in @logic.bm
Select OneHome WiFi Package
Monthly Customer Bill
Total Monthly Customer Bill*
Customer Approval
Date*
MM slash DD slash YYYY
Time of Submission*
Sound Decision Information
Sales Associate Name*
Sales Associate Employee Number*

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NextOne TV Program

Customer Information

NextOne TV Program

Security Information

Product Subscription

Monthly Customer Bill

Customer Approval

Sound Decision Information