TE data Credit Card Authorization Form Customer account number

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Customer Information

ADSL phone number*

First Name Second Name Family Name

Home Phone (1) Mobile no.

Address
Street
Name

Governorate District Building No Flat no.

Subscription Plans

1 mths
100 LE Not Available
1Mbps - 100GB speed 512
Up to the 100GB 160 LE
speed 1M
speed 200GB 260 LE
speed 2M
your Shahed Plus
landline 300GB 360 LE
speed 4M
can
support* 500GB 500 LE
speed 4M

16 Mbps

Other Packages
Unlimited ADSL (A) Tal2A (B) Home/ Business/
1 mth 3 mths 6 mths 12 mths 1 mth 3 mths 6 mths 12 mths
ADSL512k 95 280 555 1,090 ADSL TAl2A Up to 8M (5GB) 75 220 440 855
ADSL1M 140 415 820 1,610 ADSL TAl2A Up to 8M (15GB) 100 295 585 1,140
ADSL 2M 220 650 1,290 2,530 ADSL TAl2A Up to 8M (25GB) 125 370 735 1,440
ADSL4 +2M 380 1,125 2,230 4,380 ADSL TAl2A Up to 8M (40GB) 150 445 875 1,705
ADSL8 +2M 695 2,055 4,020 8,000 ADSL TAl2A Up to 8M (100GB) 250 725 1,420 2,820
ADSL16 +2M 1,355 4,010 7,845 15,600 ADSL TAL2A Up to 8M (160GB) 350 1,020 2,000 3,990
ADSL24 +2M 1,950 5,770 5,770 22,500

ADSL Packages (C)

Home/ Business/ ( ) ADSL
1 mth 3 mths 6 mths 12 mths
Home ADSL1- Mbps (10GB) 50 150 300 600 Business ADSL1- Mbps (10GB)
Home ADSL - 1 Mbps (100GB) 95 285 570 1,140 Business ADSL - 1 Mbps (100GB)
Home ADSL - 2 Mbps (150GB) 140 420 840 1680 Business ADSL - 2 Mbps (150GB)
Home ADSL - 4 Mbps (200GB) 220 660 1,320 2,640 Business ADSL - 4 Mbps (200GB)
Home ADSL - 8 Mbps (300GB) 350 1,050 2,100 4,200 Business ADSL - 8 Mbps (300GB)

Value Added Services

CPE Options Option Packs
Option 1 Option 2 Option 3
CPE Type Rent Buy
Static IPs 1 5 13
1 Port Router (Ethernet) N/A LE 150 Email Accounts N/A 5 10
Wireless -4Port Router LE 30/month LE 250 Hosting Domain N/A 20MB 30MB
Line Filter/Splitter N/A LE 15 Domain Name .eg N/A
Price
CPE Delivery Service Installation Visit
When my line is split and ADSL becomes activated, I would like TE data to send me the modem/router to When ADSL becomes activated, I would like TE data to send me a technical rep to help me get
my address. connected for the 1st time (Only in Greater Cairo and Alex)

Customer Signature:
Credit Card Information
Credit Card Number

Expiry Date Credit Card Type

Name as on Credit Card

Customer Signature:

Declaration
I hereby authorize and delegate TE data to withdraw all the due amounts and any forth amounts that might
be accrued for the subscription renewal based on my acceptance of this statement and for receiving the
services I have selected and the fees and prices in the above mentioned schedule of prices and services.
In the case of selecting one of TE datas ADSL Limited speeds, I hereby authorize and delegate TE data
to withdraw any amounts, fees and charges due to any extra usage from my Credit Card account with the
statements/details stated above during the period being specied as I undertake not to object deducting
and discounting these amounts in the bank issuing this card. If I should need to cancel my service, suspend
my service, upgrade/downgrade the speed I have agreed on with TE data, or if I wish to cancel making
payments through the above mentioned Visa/Master Card, I hereby undertake to inform TE data at least
7
Card account, I hereby undertake to pay all my dues to TE data for the services listed above until the date
of cessation of service. Also, in the case of my Credit Card expiration, I hereby undertake to inform TE data
immediately.

Customer Signature: