THE QUALITY INTERNET SERVICE PROVIDER

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CUSTOMER DATA
Full Name
Gender
 
Place & Date of Birth
,
ID Card Type
ID Card Number
Address on ID Card
Correspondence Address
Post Code
Residence Phone Number

Cellular Phone Number (CDMA/GSM)
Office Phone Number
Fax. Number
For ADSL Only
ADSL Phone Number
 
FOR COMPANY MEMBERSHIP, PLEASE ALSO COMPLETE THE FOLLOWING
Company Name
NPWP
Company Address
   
SERVICES TYPE
Time Based
FIA TIME
FIA Time Student
FIA Time 50
FIA Time 75
FIA Time 145
FIA Time 280

D~ONE Number
D~ONE Number 20 Ribu
D~ONE Number 50 Ribu
D~ONE Number 75 Ribu
D~ONE Number 145 Ribu
D~ONE Number 280 Ribu

UNLIMITED DIAL-UP
Unlimited Dial-Up 350 		Traffic Based
FIA TRAFFIC
FIA Traffic 100
FIA Traffic 250
FIA Traffic 500 		D~NET ADSL
Unlimited Business
Unlimited Enterprise

USER ACCOUNT
Username Preferences 1*
Username Preferences 2*
Username Preferences 3*
Email 1
Email 2

*) - Characters allowed are 'a' to 'z', '0' to '9',
    - 4 Characters minimum and 8 characters maximum
    - The first character must be an alphabet
PAYMENT

Payment Method :
Cash
Credit Card

Transfer to : PT. DUTAKOM WIBAWA PUTRA
                         - BII a/c 2.002.033889
                         - BCA a/c 788-085-2889

 

 

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