Customer number (optional) It can be found on the left corner of your last bill or payment statement, next to the document number {{errorMessages.CusI.required}} {{errorMessages.CusI.pattern}} {{errorMessages.CusI.pattern}} {{errorMessages.CusI.pattern}} {{errorMessages.CusI}} {{errorMessages.CusI.pattern}}

First name {{errorMessages.FirstName.required}} {{errorMessages.FirstName.pattern}} {{errorMessages.FirstName.pattern}} {{errorMessages.FirstName.pattern}} {{errorMessages.FirstName}} {{errorMessages.FirstName.pattern}}

Last name {{errorMessages.LastName.required}} {{errorMessages.LastName.pattern}} {{errorMessages.LastName.pattern}} {{errorMessages.LastName.pattern}} {{errorMessages.LastName}} {{errorMessages.LastName.pattern}}

Please indicate the type of change for which you are requesting intervention:

Replacing of a Proximus underground cable

Replacing or removing of a Proximus above ground (Facade) cable

Move or remove a Proximus street cabinet in front of the building

Relocating a Proximus cable or connection box inside the building

Installation address

Region {{errorMessages.region.required}} {{errorMessages.region.pattern}}

Street {{errorMessages.StreetName.required}} {{errorMessages.StreetName.pattern}} {{errorMessages.StreetName.pattern}} {{errorMessages.StreetName.pattern}} {{errorMessages.StreetName}} {{errorMessages.StreetName.pattern}}

Nummer {{errorMessages.HouseNumber.required}} {{errorMessages.HouseNumber.pattern}} {{errorMessages.HouseNumber.pattern}} {{errorMessages.HouseNumber.pattern}} {{errorMessages.HouseNumber}} {{errorMessages.HouseNumber.pattern}}

Box (optional) {{errorMessages.Letter.required}} {{errorMessages.Letter.pattern}} {{errorMessages.Letter.pattern}} {{errorMessages.Letter.pattern}} {{errorMessages.Letter}} {{errorMessages.Letter.pattern}}

Zip code {{errorMessages.zipCode.required}} {{errorMessages.zipCode.pattern}} {{errorMessages.zipCode.pattern}} {{errorMessages.zipCode.pattern}} {{errorMessages.zipCode}} {{errorMessages.zipCode.pattern}}

City {{errorMessages.cityName.required}} {{errorMessages.cityName.pattern}} {{errorMessages.cityName.pattern}} {{errorMessages.cityName.pattern}} {{errorMessages.cityName}} {{errorMessages.cityName.pattern}}

Prefix {{errorMessages.CALLBACKCLICountry.required}} {{errorMessages.CALLBACKCLICountry}}

Contact number (optional) {{errorMessages.CALLBACKCLIPhone.required}} {{errorMessages.CALLBACKCLIPhone.pattern}} {{errorMessages.CALLBACKCLIPhone.pattern}} {{errorMessages.CALLBACKCLIPhone.pattern}} {{errorMessages.CALLBACKCLIPhone}} {{errorMessages.CALLBACKCLIPhone.pattern}}

Email address Email address (for receiving a copy of this order) {{errorMessages.MAILBACKADDR.required}} {{errorMessages.MAILBACKADDR.pattern}} Please match the e-mail address above {{errorMessages.MAILBACKADDR.pattern}} {{errorMessages.MAILBACKADDR.pattern}} {{errorMessages.MAILBACKADDR}} {{errorMessages.MAILBACKADDR.pattern}}

Please inform us at least 8 weeks before the start of the work. We sometimes have to apply for permits or find an alternative.

Desired execution date of works {{errorMessages.installdate.required}} {{errorMessages.installdate.pattern}} {{errorMessages.installdate.pattern}} {{errorMessages.installdate.pattern}} {{errorMessages.installdate}} {{errorMessages.installdate.pattern}}

Description of works to be carried out {{errorMessages.remarks.required}} {{errorMessages.remarks.pattern}}

Building's Type {{errorMessages.building_type.required}} {{errorMessages.building_type.pattern}}

Type of changes for ‘apartment’

Proximus cables on the façade

Proximus street cabinet in front of the apartments' building

Proximus underground cables - from the apartments' building to the street

Proximus cables in the apartments' building

Type of change for ‘house’

Proximus cables in the house

Proximus underground cables - from your house to the street

Proximus cables on the façade

Proximus street cabinet in front of your house

Type of change for ‘commercial building’

Proximus cables in the house

Proximus underground cables - from your commercial building to the street

Proximus cables on the façade

Proximus street cabinet in front of your commercial building

Upload files

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