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On-line Registration
Complete the form below to order any of our services:
Registration form Wimax On Line
Name:
Surname:
(Only individuals)
DNI / CIF:
Ej: 12345678X / X12345678
Contact:
(Only companies)
E-mail:
Fax:
Web page:
Phone:
Alternate Phone:
Via:
Ej: Street, road, sidewalk...
Via name:
N° / Letter:
Ej: 2, P, s/n
Postcode:
Town:
Province:
Alternate address:
Via:
Ej: Street, road, sidewalk...
Via name:
N° / Letter:
Ej: 2, P, s/n
Postcode:
Town:
Province:
How did you find us?:
Contract:
Basic Connection - 6 Mbps - 24,20 €/month vat inc. to stay
Basic Connection - 6 Mbps - 30,25 €/month vat inc. without permanence
Basic Connection 4G - 6 Mbps - 24,20 €/month vat inc. to stay
Basic Connection 4G - 6 Mbps - 30,25 €/month vat inc. without permanence
Connection Pro - 8 Mbps - 30,25 €/month vat inc. to stay
Connection Pro - 8 Mbps - 36,30 €/month vat inc. without permanence
Connecting Pro 4G - 10 Mbps - 30,25 €/month vat inc. to stay
Connecting Pro 4G - 10 Mbps - 36,30 €/month vat inc. without permanence
Connecting Pro20 - 20 Mbps - 36,30 €/month vat inc. to stay
Connecting Pro20 - 20 Mbps - 42,35 €/month vat inc. without permanence
Connecting Pro30 - 30 Mbps - 42,35 €/month vat inc. to stay
Connecting Pro30 - 30 Mbps - 48,40 €/month vat inc. without permanence
Second residence offer:
NO
YES
Comments:
I accept the
Data Protection Policy
Basic information about data protection - Responsable: WIMAX ON LINE SL. Purpose: Process your registration as a client. Legitimation: Execution of the contract. Recipients: We do not communicate your data. Rights: You can access, rectify, delete your data, and exercise other rights. Additional information: You can consult additional information by accessing our Data Protection Policy at www.wimaxonline.es.
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