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I wish to apply for Rocket Broadband Services. I am authorised to act on behalf of the business or residence on this matter. I have read, understood and accept the terms and conditions detailed at here. Monthly fee payable in advance. I am over 18 years of age. Minimum term applies.

By completing this application form you are entering into a contract for service. You have the right to cancel this contract within 14 days at no penalty before the installation takes place.

After installation, any charges incurred in providing the service up to that point will be payable.

Select Product----Wireless packages----Rocket 20MbRocket 50MbRocket 60MbRocket 70Mb----Wexford Fibre----Siro 500Siro 1000----Rural Fibre----Fibre 100Fibre 500Fibre 1000----Business packages----Rocket Stream 500Rocket Pulse 500Business Pro


Add free VoIP service:
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Please select minimum contract term.
6 month €99 Installation - Wireless Only18 month €49 Installation24 month €49 Installation

Direct Debit Mandate

Creditor Identifier: IE20ZZZ303961

Skytel Networks Ireland Ltd

M2 McConnell Business Hall,
Kerlogue Industrial Estate,
Wexford,
Y35 TR7W

Please note that as you have signed up online or by telephone and have not signed a paper mandate, you
authorise (A) Skytel Networks to send instructions to your bank to debit your account and (B) your bank to debit
your account in accordance with the instruction from Skytel Networks.

As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your
agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your
account was debited. Your rights are explained in a statement that you can receive from your bank.

Account Name (required)

Account Address (required)

Bank Name (required)

BIC (required)

IBAN (required)

Is bank account an ROI bank account? (If no, please contact our office on 053-9126860 to proceed.)
Yes

Is more than one signatory required on this account? (If yes, please contact our office on 053-9126860 to proceed.)
No

Can this bank account accept direct debits? (If no, please contact our office on 053-9126860 to proceed.)
Yes

Please select payment type:
RecurringOnce Off