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CUSTOMER DATA
Full Name
Gender
Male
Female
Place & Date of Birth
,
Month
January
February
March
April
May
June
July
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September
October
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Day
01
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05
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08
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21
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1936
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ID Card Type
-------------------------
KTP
SIM
Paspor
Kartu Pelajar
Kartu Mahasiswa
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
Standard Dial Up 5 Hours (Student Package)
ISDN Dial Up Standard
Standard Dial Up 10 Hours
ISDN Dial Up 50 Hours
Standard Dial Up 20 Hours
ISDN Dial Up 100 Hours
Standard Dial Up 50 Hours
ISDN Dial Up Unlimited
*
Standard Dial Up 100 Hours
Standard Dial Up Unlimited
Traffic Based
Traffic Based Silver (100 MB)
Traffic Based Gold (350 MB)
Traffic Based Platinum (1 GB)
D~NET ADSL
Unlimited Business
Unlimited Enterprise
*
Please call our marketing department at (031) 548-0500 for availability and prices
USER ACCOUNT
Username Preferences 1
*
Username Preferences 2
Username Preferences 3
Email 1
Email 2
*
Your username will be your primary email address
Setting Default WiFi access time per month (only for time-based service)
Standard (10 Hours)
5 Hours
20 Hours
50 Hours
100 Hours
200 Hours
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