iPass Form

iPass Usage Application Form

Print out the application form below. Fill it in, sign it, and either fax it us on +44 (0) 870 887 8863 or send it by post to the address shown on the form. Please make sure that you have read the Terms and Conditions, first.

Please complete this form and return to:

Customer Provisioning
Netscalibur UK Ltd
9-11 Selsdon Way,
London
E14 9GL

I agree to the terms and conditions laid out in the following sections:

Netscalibur's Terms and Conditions for iPass Usage
The iPass User Agreement

I have included proof of ID in the form of either:

A photocopy of a recent bank statement or
A photocopy of a recent credit card statement and photocopies of both sides of the card itself.

Full Name:

Netscalibur UserID:

Signature:

Account holder address:

Day time telephone number:
(Must be in the UK)

Evening telephone number:
(Must be in the UK)

NOTE: You will only be able to access iPass after we have contacted you to confirm these details.