BT Total Broadband - Shareholder Promotion

Claim your Welcome Cheque by filling in and submitting the form below. Order before the 28th of February and Claim by the 31st March 2009.

Your Information

Enter your Name, Address, and Email Address below:

First Name:
Last Name:
Address 1:
Address 2:
City:
Post Code:
Email Address:
	We will send a confirmation to this Email Address.

Order Information

Enter the Telephone Number you are having upgraded to broadband (ADSL Telephone Number) and your unique Order Reference Number (which was listed in the confimation of your order), and your shareholder reference number. This information is required to validate your application.

ADSL Telephone Number:		*Note that this is not your Broadband Talk Tel. No.
	Example: ABC01234567.THIS IS NOT YOUR BT ACCOUNT NUMBER. Alphanumeric only, no spaces, dashes, or symbols. You will receive an automatic e-mail response once you complete this form which you should retain and send in any future correspondence with BT. However if you have entered incorrect information and your claim cannot be verified then you will receive no future response to this claim or welcome cheque.
Confirm:	Entry is hidden for verification.

Order Reference Number:
	Example: ABC01234567
Confirm:	Entry is hidden for verification.

Shareholder Reference Number: