Print  |  Return

Address/Information Change Form for ADSL Service

SENTEX COMMUNICATIONS - 240-D Holiday Inn Drive, Cambridge ON N3C3X4 - ph. (519) 651-3400 fax (519) 651-2215
Please enter Your Sentex User ID:  _____________@sentex.ca
Your Current Information:

Telephone number on which the service is installed: (      ) _____-_______________
Name: __________________________________________________________
Address: _______________________________________________________
________________________________________________________________

Comments:
Change Information:
Will your telephone number and address stay the same?  Yes (    ) or No (    )
Have you or will you be changing telephone providers?  Yes (    ) or No (    )
             If so,  who is the new Telephone provider? _______________________
 
If you have changed Address & or Telephone Number:
Telephone Number the service is to be installed on: (        ) ______-__________________
Name on the Telephone Bill: _____________________________________________________
New Service Address: _________________________________________________________
___________________________________________________________________________
Date telephone number will be active: ____________________, 200___
Contact Name & telephone number: ________________________________________________
___________________________________________________________________________
Name of Business (if Applicable): _________________________________________________
Please note:
  • We cannot move the service until the telephone number has been activated at the new location.
  • Please ask your telephone provider for your move order number (this will facilitate the process).
  • You may have 4-7 days of down time until the service is applied to the line.
  • You may use the Sentex dial-up service at no cost during the moving your service.
  • In order to process the change to your service, there will be a $50.00 Service fee (Wholesale Gateway Access Service Charge) that must be paid in full before the change can be processed.

Signature:______________________________________    Date:______________________
Office Use:
Changes made by:______________________________________  STC:______________ Customer Number ____________
NOTES: