Rep New Form

Select Page

Date / Time *

Sales Rep *

Sales Rep Contact Number *

Client Company Name *

Contact First & Last Name *

Client Email *

Client Contact Number *

Client Address

Account Number or a Mobile Number

Select Options

Number Of Lines *

Notes

Forborne\Non-Forborne

Is it a Winback?

Static IP - 5 Static IP for $12\month

Speed

Add promo if there is one

Choose Free Telus public Wifi

Notes