Please enable JavaScript in your browser to complete this form.Fields marked with an * are required If you would like to apply for Leased Line, please fill in your details in this Form below and you will be automatically notified by our Representatives. Should our Agents/Representatives fail to reply to your request, please call us at our toll free number 1600 or email to us at 1600@bt.bt/webmaster@bt.bt. Please ensure that the fields marked in asterisk(*) are filled,ticked or chosen. Customer DetailsName(Individual/Organization) *Location *ThimphuParoHaaPunakhaGasaTrongsaSamdrup JongkharTsirangSarpangChukhaWangduephodrangTrashigangTrashiyangtseLhuntseBumthangPemagatshelDaganaSamtseMongarZhemgangSelect the DzongkhagPlease specify your exact location/address *CID (if individual) *Contact No: *Please provide your contact numberEmail Address *Choose your choice of bandwidth *2 Mbps3 Mbps4 Mbps5 Mbps6 Mbps7 Mbps8 MbpsRouter Required?YESNO *One time annual charge of Nu. 75/- per IP address shall be applicable *The installation charge of Nu. 2,500 shall be applicable *The shifting charge of Nu. 2,500 shall be applicable *The Media Converter charge shall be applicable Switch Required?YESNO*For pricing on router and switches please contact nearest BT office or call 1600 Application Date *(Effort is made to perform installations in a timely manner, however please note that installations will be made on a first-come-first served basis) Service can be activated any day of the month, billing shall commence from the day of activation DeclarationI hereby agree to the terms and conditions laid down on the agreement form Terms & Conditions Upload a ID copy of applicant * Click or drag a file to this area to upload. Upload a ID copy of surety * Click or drag a file to this area to upload. Download Leased Line Application Form Upload scanned copy of Leased Line Application form * Click or drag a file to this area to upload. Others: A copy of license or relevant documents Click or drag a file to this area to upload. Application must be submitted with mandatory documents (stated above). Failure to do so will mean rejection of your application. I agree terms and condition *I AGREE TERMS AND CONDITIONSSUBMIT Previous Article Previous Article Domain Registration Next Article Next Article Broadband Application