|
| 1.0 Type of Application |
| Type of Application |
|
| Packages |
|
| |
|
| 2.0 Personal Details |
Name of Applicant
*as per NRIC / Passport |
|
| Installation Address |
|
| City |
|
| Postcode |
|
| State |
|
Tel. No.
*where
tmnet streamyx is to be connected |
|
| Home No. |
|
| Office Tel. No. |
|
| Fax Tel. No. |
|
| Mobile No. |
|
| Email |
|
| NRIC |
|
Passport No.
*Non-Malaysian Citizen |
|
| Date of Birth |
|
| Gender |
|
| Preferred access Login ID |
|
| Preferred email Login ID |
|
| |
|
| 3.0 Invoicing and Billing Information ( Leave blank if same as above ) |
| Billing name |
|
| Billing address |
|
| City |
|
| Postcode |
|
| State |
|
| Country |
|
| Contact Person's Email Address |
|
| |
|
| |
|
| |
|
