Letter logo

Fax this order form to 0800 11 333 Or e-mail it to [email protected] 1. Administrative data
To be filled in by salesperson
Type of contract
Follow-up
BCI opportunity no.: …………………………………………………………………………………………………………… Seller type
External resel ing partner (indirect sales) Seller data
Name: ……………………………….……………………………………………………………………………………………….…… Partner ID:…………………….……………………………………………………………………………………………….………. Tel.: ………………………………………………… Mobile: .……………….…………………………………………….…… Fax: ……………………………….……………………………………………………………………………………………….………. E-mail: ………………………………….…………………………………………………………………………………………….… I want to transfer my Becloud e-Commerce data (domain, login and password) to my partner to let him carry out the initial configuration. I agree for Belgacom to transfer these data directly to this partner to give him access to my data for this configuration. (to be filled in by the customer)
Customer data
Customer name: .…………………….………………….……….…………………………………………….…………… Street + number: .……………………….………………….……….…………………………………………….…………… Postal code + municipality: .…………………….………………….……….…………………………………….……… VAT number BE - … … … . … … … . … … … Customer number (on your Belgacom bill): .……………….…………………………………………….……. Billing information
Name and billing address are the same as the customer address Name and billing address are not the same as the customer address Name: .……………….………………………………….…………………………………………………….………………….……. Street + number: .……………….……………………………………………………………………….………………….……. Postal code + municipality: .……………….………………………………………………………….…………………. Tel.: ………………………………………………….……… Fax: .……………….………………………….……………………. Technical contact person
Name: ….……………….………………………………………………………………….………………….………………………… First name: ….………………….………………………………………………………………….………………….………………. Tel.: ………………………………………………… Mobile: .……………….……….……………………………….…………… E-mail: ….……………….………………………………………………………………….…………….……………………………. Please provide a valid e-mail address. The Becloud e-Commerce login details wil only be sent to this e-mail address. Your Becloud e-Reservation or Becloud e-Shop wil be made available online via a standardized domain name: http://e-commerce.becloud.be/epages/<bestelreferentie>.sf. You can personalize your domain name in a later stage. You wil find more information on how to do this in the welcome mail that you wil receive upon activation of your e-Commerce pack. Administrative
Name: ….……………….………………………………………………………………….………………….………………………… First name: ….………………….………………………………………………………………….………………….………………. Tel.: ………………………………………………… Mobile: .……………….……………………………………….…………… E-mail: ….……………….…………………………………………………………….………………….……………………………. Belgacom SA under public law, Bd du Roi Albert I 27, B-1030 Brussels, VAT BE 0202.239.951, Brussels Register of Legal Entities, Giro 000-1710031-18 Belgacom Group ISO certificates: www.belgacom.com Fax this order form to 0800 11 333
Or e-mail it to [email protected]


2. Field of application and tariff information
Service flavors
Basic offer– Becloud
Quantity
Monthly price per
Short specifications
e-Commerce1
workstation (excl.
Becloud e-Reservation
10 Products / 25 Reservations / 25 webpages Becloud e-Shop Start
1000 Products / 25 Reservations / 100 webpages Becloud e-Shop Comfort
1000 Products / 50 Reservations / 100 webpages 2 currencies / 3 languages / extra features Becloud e-Shop Favorite
10,000 Products / 150 Reservations / 1000 webpages 100 currencies / 13 languages / extra features 1Al prices are VAT exclusive. ²First month is free Only one choice possible in the Becloud e-Commerce basic offer. Desired preset language of the administrator interface Please select the default language of your choice for the administrator interface. It is stil possible to change the language choice after completing the initial online set-up assistant. This language setting has no impact on the language choice in the public section of your Becloud e-Reservation or e- Shop. Your personal login and password for the administrator section of your Becloud e-Reservation or e-Shop wil be sent to you in a welcome e- Options – Becloud
Quantity
One-time price (excl.
Short specifications
e-Commerce1
Becloud Perso & Design pack
Belgacom SA under public law, Bd du Roi Albert I 27, B-1030 Brussels, VAT BE 0202.239.951, Brussels Register of Legal Entities, Giro 000-1710031-18 Belgacom Group ISO certificates: www.belgacom.com Fax this order form to 0800 11 333 Or e-mail it to [email protected] 3. Additional services
Activation services
As part of the Becloud e-Commerce total concept, our Preferred Partner may contact you with ful information on the special conditions and service for online payments and logistics services related to the usage of products within Becloud e-Commerce. We will share your details only with our Preferred Partners for Becloud e-Commerce in order to keep you as comprehensively informed as possible. I do not want to be contacted by a Becloud e-Commerce Preferred Partner and do not want to be personal y informed about the special rates applicable to online payments and logistics related to the usage of Becloud e-Commerce. 4. Specific conditions for the Customer
Please fill in your remarks about this solution below (if any).
5. Signature
Customer's consent

By signing this Order Form, the Customer agrees to the delivery of the Products and/or Services listed in Chapters 2/3/4, in
accordance with the Agreement, the related General Terms and Conditions and the applicable Contractual Service Descriptions
(see www.belgacom.be).
Date: …………/…………/20……….
Name of the signatory: ………………………………………………………………………………………… Position of the signatory: ……………………………………………………………………………………………………. ……………………………………………………………………… ……………………………………………………………………… Belgacom SA under public law, Bd du Roi Albert I 27, B-1030 Brussels, VAT BE 0202.239.951, Brussels Register of Legal Entities, Giro 000-1710031-18 Belgacom Group ISO certificates: www.belgacom.com

Source: http://becloud.be/dms/products/others/ecommerce/Becloud-e-Commerce_Order-form--EN-/Becloud%20e-Commerce_Order%20form%20(EN).pdf