Order Form

School / Organisation Name:

DFE Code:

Order Number:

Address:

LGfL Service Option:

Broadband Connection Speed:

Resilient Line Connection Speed:

^{* denotes a required field}

Installation Details

New Build (Yes/No)^*

Comms Cabinet Room Number or Name^*

Comms Cabinet Floor^*

Comms Cabinet Building^*

Preferred Router and Firewall location (if different from above)

Upload picture of Comms Cabinet

Current provider contract end date^*

Preferred line commissioning date^*

Project Lead Details

Main contact for co-ordinating delivery of service, they will need to be able to provide or arrange access to the site

Project Lead Contact name^*

Project Lead Contact Email^*

Project Lead Contact Phone^*

Contract Recipient

Who should the LGfL Broadband Contract be sent to?

Contract Recipient First Name^*

Contract Recipient Last Name^*

Contract Recipient Email Address^*

Billing Information (Invoice will be sent to this address and must match any PO issued)

Use service address as billing address

Billing Address Company^*

Billing Address 1^*

Billing Address 2

Billing Address City^*

Billing Address County

Billing Address Post Code^*

Billing Email address (invoice will be sent to this address)^*

Contacts Required for Delivery of Service

Head Teacher Name^*

Head Teacher Email Address^*

SBM / Finance Name^*

SBM / Finance Email Address^*

IT Contact Name^*

IT Contact Email Address^*

IT Contact Phone^*

LGfL Customer Broadband Order Form