Name
ALL FIELDS ARE MANDATORY
Company/Dept.
Address
City/State
Country
Phone/Fax
Email
Short Description of VC
DATE OF VC
(dd/mm/yy)
START TIME (Israel time)
END TIME (Israel time)
START TIME (Local time)
END TIME (Local time)
Please complete information for
either
Point-to-Point or Multipoint:
POINT-TO-POINT
MULTIPOINT
Point A - Jerusalem (dialing out)
Point A -
Location
Location
No. Participants
No. Participants
Contact person
Contact person
Telephone
Telephone
Email
Email
Technician
Technician
Email
Email
ISDN #
ISDN or IP #
Bandwidth
Bandwidth
Point B -
Point B -
Location
Location
No. Participants
No. Participants
Contact person
Contact person
Telephone
Telephone
Email
Email
Technician
Technician
Cell
Email
ISDN or IP #
ISDN or IP #
Bandwidth
Bandwidth
Please note that Jerusalem will dial out
We will contact you to schedule a test once VC is approved.
Point C -
Location
No. Participants
Contact person
Telephone
Email
Technician
Email
ISDN or IP #
Bandwidth
Please provide details for additional points on separate
page. The Bridge Provider will contact each point to
schedule tests.
