Infrastructuuraansluiting

Personal data

Title {{errorMessages.title.required}} {{errorMessages.title.pattern}}

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

Name {{errorMessages.LastName.required}} {{errorMessages.LastName.pattern}} {{errorMessages.LastName.pattern}} {{errorMessages.LastName.pattern}} {{errorMessages.LastName}} {{errorMessages.LastName.pattern}}

Installation address

{{errorMessages.lomKey}} The field is mandatory

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 (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}}

Wish date of installation ( airtight building ) {{errorMessages.installdate.required}} {{errorMessages.installdate.pattern}} {{errorMessages.installdate.pattern}} {{errorMessages.installdate.pattern}} {{errorMessages.installdate}} {{errorMessages.installdate.pattern}}

Comments (optional) {{errorMessages.comments.required}} {{errorMessages.comments.pattern}} {{errorMessages.comments.pattern}} {{errorMessages.comments.pattern}} {{errorMessages.comments}} {{errorMessages.comments.pattern}}

Choose a date, then a time slot when we can contact you

Date on which you want to be contacted

There are some time slots free for this date, please pick one below.
Please fill in all the above required fields so we can propose you time slots
We do not find any slots available for the date you selected. Please pick another one.

{{errorMessages.selectedCallbackDate.required}} {{errorMessages.selectedCallbackDate.pattern}} {{errorMessages.selectedCallbackDate.pattern}}

Invoicing address

Street {{errorMessages.StreetName_Invoice.required}} {{errorMessages.StreetName_Invoice.pattern}} {{errorMessages.StreetName_Invoice.pattern}} {{errorMessages.StreetName_Invoice.pattern}} {{errorMessages.StreetName_Invoice}} {{errorMessages.StreetName_Invoice.pattern}}

Number {{errorMessages.HouseNumber_Invoice.required}} {{errorMessages.HouseNumber_Invoice.pattern}} {{errorMessages.HouseNumber_Invoice.pattern}} {{errorMessages.HouseNumber_Invoice.pattern}} {{errorMessages.HouseNumber_Invoice}} {{errorMessages.HouseNumber_Invoice.pattern}}

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

Zipcode {{errorMessages.zipCode_Invoice.required}} {{errorMessages.zipCode_Invoice.pattern}} {{errorMessages.zipCode_Invoice.pattern}} {{errorMessages.zipCode_Invoice.pattern}} {{errorMessages.zipCode_Invoice}} {{errorMessages.zipCode_Invoice.pattern}}

City {{errorMessages.cityName_Invoice.required}} {{errorMessages.cityName_Invoice.pattern}} {{errorMessages.cityName_Invoice.pattern}} {{errorMessages.cityName_Invoice.pattern}} {{errorMessages.cityName_Invoice}} {{errorMessages.cityName_Invoice.pattern}}

I would like to be kept informed about products, services, contests and promotions of Proximus. 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. I’m aware that my data is processed in accordance with Proximus' privacy notice which informs me how to manage my privacy settings.

Send

iPhone 16

Request for modification of the Proximus infrastructure

Personal data

Installation address

Choose a date, then a time slot when we can contact you

Invoicing address

Join us

Request for modification of the Proximus infrastructure

Personal data

Installation address

Choose a date, then a time slot when we can contact you

Invoicing address

Please wait, your data is being processed

Join us