Velstar International · Independent Technology Consultant

Service Order Agreement — Information Request

Complete this once and a Velstar advisor will follow up — no emailed PDFs. Fields marked with * are required for all quotes and orders.

Installation information

Installation address

Floor / suite number

City

State

ZIP

Local contact phone (mobile preferred)

Local contact email

Billing contact

Billing contact name

Title

Billing address

Suite number

City

State

ZIP

Billing phone (mobile preferred)

Billing email

Technical contact

Technical contact name

Title

Technical phone (mobile preferred)

Technical email

Service request

Primary circuit

Primary internet circuit (100/200/500 Mbps or 1/10 Gbps)

Transmission media (Fiber / Coax / Fixed Wireless)

Managed router and/or cable modem

IP addresses (Static) or DHCP + quantity

Service term (MTM / 12 / 24 / 36 month)

Requested in-service date

Second circuit (optional)

Second circuit (100/200/500 Mbps or 1/10 Gbps)

Transmission media

Managed router and/or cable modem

IP addresses (Static) or DHCP + quantity

Service term

Requested in-service date

Additional notes (service/installation, or other services — phone, A/V conference)

Current bill (optional)

Upload a copy of your current bill — helps us match your service

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PDF or image (JPG/PNG), up to 10 MB

Choose file…