Info request on Fiber

By submitting this form, I consent that Proximus, as data controller, stores my personal data, included in this form, in its records in order to contact me by telephone, post and/or digital channels (email and/or SMS) to inform me about the roll-out of fiber and thus receive all related commercial offers. I have the right to withdraw my consent at any time. My data will be processed in accordance with the Proximus privacy policy, which informs me how to withdraw my consent.

Your data

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

Name {{errorMessages.name.required}} {{errorMessages.name.pattern}} {{errorMessages.name.pattern}} {{errorMessages.name.pattern}} {{errorMessages.name}} {{errorMessages.name.pattern}}

E-mail address {{errorMessages.email.required}} {{errorMessages.email.pattern}} Please match the e-mail address above {{errorMessages.email.pattern}} {{errorMessages.email.pattern}} {{errorMessages.email}} {{errorMessages.email.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}}

Installation address

Street {{errorMessages.street.required}} {{errorMessages.street.pattern}} {{errorMessages.street.pattern}} {{errorMessages.street.pattern}} {{errorMessages.street}} {{errorMessages.street.pattern}}

Number {{errorMessages.number.required}} {{errorMessages.number.pattern}} {{errorMessages.number.pattern}} {{errorMessages.number.pattern}} {{errorMessages.number}} {{errorMessages.number.pattern}}

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

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

City {{errorMessages.city.required}} {{errorMessages.city.pattern}} {{errorMessages.city.pattern}} {{errorMessages.city.pattern}} {{errorMessages.city}} {{errorMessages.city.pattern}}

Your question

Communication preferences

Check the box below if you wish to receive other communications from Proximus, not specific to fiber:

I would like to be kept informed about products, services, contests and promotions of the Proximus Group. To this end, Proximus may store my personal data in its files and may contact me, including by phone and via electronic channels such as e-mail, SMS and social media. Proximus may share my data with its subsidiary Scarlet. I’m aware that my data is processed in accordance with Proximus' privacy policy which informs me how to manage my privacy settings. See also the privacy policy of Scarlet.

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iPhone 16

Info request on Fiber

Your data

Installation address

Your question

Communication preferences

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Info request on Fiber

Your data

Installation address

Your question

Communication preferences

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