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CLIENT PREMISES EQUIPMENT (CPE) INSTALL/REPAIR REPLACE INFORMATION

DATE:____________________________

CLIENT NAME/ ANTENNA or MAC ADDRESS IP ADDRESS USED/ ACCESS POINT NAME ANTENNA REMARKS
ANTENNA NAME/ FIBER ONU WRITE FULL MAC ADDRESS IF NEW REGISTER USER AND PASS
MODEM or
ADDRESS/NUMBER ONLY LAST 4 CHARACTER IF 2ND HAND

FILLUP BY NAME & SIGNATURE/DATE: _________________________________

ACCEPTED BY NAME & SIGNATURE/DATE: _______________________________

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