Bandwidth Application & Local Dealer Survey Form

Ref# / Survey Date (Auto System Date & Time)

Subscriber / Panel Name

Franchise Branch

Installation Address (City / Locality)

CNIC Number

Contact Person

Designation

Mobile Number (WhatsApp Enabled)

Primary Email

Connectivity Media (Fiber Optic / FTTH / Wireless)

Expected Users

IP Subnet / Pool Allocation

Last Mile Service Provider / Network Vendor

Commissioning / Connection Target Date

Monthly Recurring Charges - MRC (PKR)

One-Time Installation / OTC (PKR)

Key Account Manager / Local Dealer Name (Fixed)

Dealer Helpline / Support Contact (Fixed)

Value Added Services (Static IP, WebTV, Cloud, Switch, Media, SFP)

Sales Remarks / Discount Details

Technical Feasibility / Fiber Distance Remarks

DEALER SALES & TECHNICAL SURVEY FORM

Ebone Network (Pvt) Ltd.
Ref# (MANUAL) \| Survey Date & Time
SUBSCRIBER DETAILS
Subscriber / Panel Name
Franchise Branch
Installation Address
CNIC Number
Contact Person
Designation
Mobile Number (WhatsApp)
Primary Email
PACKAGE & CONNECTIVITY DETAILS
Connectivity Media
Expected Users
IP Subnet / Pool
Last Mile Vendor
BILLING & COMMERCIAL TERMS
Commissioning Date
Monthly Recurring Charges (MRC)
Installation Charges (OTC)
OFFICIAL & FEASIBILITY DETAILS
Key Account / Dealer Name
Dealer Contact Number
Value Added Services
Sales Remarks
Technical Feasibility Remarks
Abid Islam ________________________ KAM / DEALER SIGN	________________________ APPROVED BY CEO / NOC

Ebone Network - Local Dealer & ISP Survey System