Service Commissioning Form

Customer Identification Number (CID):

Client Name:
Address:
Contact Person:
Phone No:

Provided Service: ☐Internet ☐ Intranet (Data Connectivity) ☐Dark Fiber

Type of Service: ☐ FTTx ☐ Media Converter (MC) ☐ No active Device
Connected Device: ☐ Router ☐ Switch/Hub ☐ DVR ☐ PC/Laptop
Client Device Settings Router Description
(If Router): (Brand and Model no)
ICMP (Ping from Wan) ☐ On ☐ Off
Connection Installation Remote Management ☐ On ☐ Off Port No:
Successfully Completed Router Login Password
Wireless SSID
☐Yes ☐ No Wireless Connection Password

IP Details:
IP: Residence Type:
PPPOE User: Pass:
Prev. ISP Name: Reason Prev. ISP Discontinue:

Used Materials (Ownership Amber IT-Refundable)

Product Name Qty Descriptions
ONU
Optical Cable
UTP Cable
TJ Box
Patch Cord
Others

I acknowledge the successful installation with the information provide and receiving the Network Connection/
Configuration established successfully to the acknowledged satisfaction level. I/ We have received all the
equipment’s in working condition as stated above.

_________________ _________________

Client Signature & Date Installation Engineer

Navana Tower (7th Floor), 45 Gulshan South C/A, Circle – 1, Dhaka – 1212, Bangladesh, Phone: +88 09611 123 123, +88 02 8819252, Fax: +88 02 8819221
E-mail:info@amberit.com.bd Web : http://www.amberit.com.bd