Name:

Surname:

(Only individuals)

DNI / CIF:

Ej: 12345678X / X12345678

Contact:

(Only companies)

Web page:

Phone:

Alternate Phone:

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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