CONSUMER

Application Form

New Service Re-sign Home Phone Broadband TV Mobile Bundles

Existing customer? YES NO Flow Account #: Flow Service #:

Please complete form in BLOCK LETTERS and place an (x) or the amount in the appropriate boxes and spaces.

YOUR INFORMATION Title (Mr. / Mrs. / Ms. / Miss) Please circle one.
First Name: Lira Middle Name: Eureka
Last Name:
Prentice Nationality:
Barbadian
Photo ID Type and No.
9206060064 Date of Birth (day/mth/yr)
06/06/1992
(Passport/Drivers License/National ID)

Date of Issue: Place of Issue:

Contact Numbers: (H)

4269251 (W) (M)
2485223
(At least 2 contact nos. required)

Billing Address:
Hall’s road st Michael
(If different from service)

Email Address:
[email protected]

ALTERNATE CONTACT INFORMATION

Alternate Contact’s Name:
Lucia terrence Relationship:
Mother
Alternate Contact’s Address:
Halls road st michael

Contact Numbers: (H)

426 9251 (W) Email Address:

Name(s) of Authorised signatories on Account: Full authorization means authority to access, report faults &
Circle the correct option and please provide copies of their IDs. make inquiries on account and make all changes to account
(including plan/billing information, contact details,
(1) Full/Partial relocate/add/cease services). Partial authorization means some
(2) Full/Partial of the above. Please indicate in space provided, as applicable.

NON NATIONALS

Overseas Address:

Contact Numbers: (H) (W) Social Security #:

EMPLOYMENT DETAILS Employment Status: Employed Self Employed Student Retired Unemployed Diplomat

Profession/Occupation: Appointment specialist

Employer’s Name: Ansa motors
Employer’s Address:
Wildey st michael

Contact Numbers: (1)

467 2503 (2) (Fax #)

SERVICE DETAILS

Is an appointment needed to install service? YES NO Do you own the property where service is YES NO
required?
If no, state landlord’s name:
Date service required Letter of consent MUST accompany application.

Landlords telephone #:

Was there a telephone at this address before? YES NO If yes, state previous telephone #:

Service Address:

Directions to Service Address:

Please tick the appropriate boxes, if you wish to receive promotional messages: SMS EMAIL

Please select the option(s) that best describes your wiring: Conduit Underground Surface Don’t Know

Nearest FLOW home phone customer #:

Cable & Wireless (Barbados) Limited ~ P.O. Box 272 Windsor Lodge, Government Hill, St. Michael, Barbados - Tel 292-5050 - Web: www.discoverflow.co
MOBILE PLANS

COMBO PLANS COMMMENTS

SMALL MEDIUM LARGE X-LARGE

500 MB of Data 1.5 GB of Data 3 GB of Data 5 GB of Data
200 Call Mins 400 Call Mins 700 Call Mins 1000 Call Mins
200 Local SMS 500 Local SMS 100 Intl. Call Mins 200 Intl. Call Mins
3 GB MyCloud 3 GB MyCloud 2000 Local SMS 2000 Local SMS
25 GB MyCloud 25 GB MyCloud
MY ROAM PLAN
XX-LARGE MYCLOUD FAMILY SHARE MOBILE PROMOTION
7 GB of Data My Roam Plus My Roam Essential
Premium 25GB 1 additional user ________________
2800 Call Mins 30 Day Package 30 Day Package
200 Intl. Call Mins Premium 50GB 2 additional users ________________ 500 Mins of outgoing calls 200 Mins of outgoing calls
2000 Local SMS 3 additional users ________________
Free incoming calls & SMS Free incoming calls & SMS
50 GB MyCloud 1 GB of Data 500 MB of Data

BROADBAND HOME PHONE

PLAN SPEED HOME PHONE PACKAGES VOICE FEATURES

Fibre Basic 15 Mbps Home Phone Basic Voicemail Automatic Busy Call Back Vanity Name
Fibre Essential 30 Mbps Home Phone Essential Call Waiting Selective Call Rejection Smart Ring
Superfast Fibre Plus 60 Mbps Home Phone Plus Caller ID Automatic Recall Anonymous Caller
Superfast Fibre Max 150 Mbps Home Phone Max Call Forwarding Debar Calls Rejection
3-Way Calling Unlisted Number
Superfast Fibre Turbo 250 Mbps
Superfast Fibre Ultra 350 Mbps
WORLDPAK TELEPHONE DIRECTORY INFORMATION
Superfast Fibre Giga 1000 Mbps
WorldPak Directory Listing: Standard Listing* Unlisted *As at service address
WorldPak Lite

FLOW TV + CLOUD PERSONAL VIDEO RECORDER (PVR) PACKAGES

PACKAGES ADDITIONAL PVR HOURS

Essential (5 Hours PVR Incl.) Plus (10 Hours PVR Incl.) Max (15 Hours PVR Incl.) 10 Hours 25 Hours 100 Hours

ADDITIONAL PACKAGES

Family Time B4U Music & Movie Combo Fox Movie Pack A La Carte Ch. #:
In The Know Zee Cinema & Zee TV Combo HBO / / / / / / /
Entertainment Zone B4U & Zee Combo MAX
/ / / / /
Fans Central Max Pak HBO/MAX Combo
Flow Your Own Ch. #: Flow Sports Premier Pack All-In Movie Combo Added Set-Top Boxes
/ / / / / / / Quantity Required:
(Note - First box included)
/ / / / / Promotions - Promo Type:

BUNDLE PACKAGES
TRIPLE PLAY BUNDLES UPGRADE YOUR BUNDLE
BUNDLES TV BROADBAND FIXED VOICE PLAN BROADBAND
Essential Bundle TV Essential Fibre Basic Home Phone Essential 30 Mbps 250 Mbps
60 Mbps 350 Mbps
Plus Bundle TV Plus Fibre Basic Home Phone Essential
150 Mbps 1000 Mbps
Max Bundle TV Max Fibre Basic Home Phone Essential
HOME PHONE

Home Phone Plus

Home Phone Max

CONTRACT TERM: 12 months 24 months

DECLARATION
I acknowledge that I am the person named and identified on this application form. I agree to pay for the above service(s), applied for by me,
in accordance with the applicable rates and charges. I agree to abide by Flow’s Terms & Conditions of Service and any additional terms or
rules applicable to the plan(s) I subscribe to, all of which I have received, read and understood. I also agree, in the event of non-payment of
the account, to pay all legal fees and expenses incurred in the collection of the account, including debt collection.

Together this application form, the Terms and Conditions of Service and the relevant plan rules shall be referred to herein as the Agreement.
I understand and agree that the Agreement is for the minimum contract length indicated above and, should I cancel early, I accept that an
early cancellation fee will apply together with any outstanding payments. I agree that this cancellation fee is not a penalty and is a genuine
estimate of damages due to Flow for early termination of the Agreement.

I hereby declare that all of the information on this application form is true and accurate. I agree that Flow has the right to terminate this
Agreement in the event any of the information provided by me herein is false or incorrect. This application is not effective until accepted by
Flow or Flow provides service, whichever occurs first.

Lira prentice Date:

9/20/2024
Customer (Signature) Customer (Print) Service Rep. (Signature) Service Rep. (Print)

FOR FLOW OFFICIAL USE ONLY

Total Monthly Service Charges: $ Credit Limit: $ Receipt #:
Service Order #: Account #:

IMSI/SIM #: IMEI: PIN/PUK #:

Pole ID #: LCP #:

Handset Manufacturer: Model No.:

Security Question: Answer:

Cable & Wireless (Barbados) Limited ~ P.O. Box 272 Windsor Lodge, Government Hill, St. Michael, Barbados - Tel 292-5050 - Web: www.discoverflow.co