Customer Registration Form (Broadband Internet)
(Fields with
*
are must required)
Full Name
*
Mobile No.
*
Email Address
*
NID
(Optional)
District
*
select
ID
NAME
Upazila/Thana
*
select
ID
NAME
Address
*
Connection For
*
select
ID
NAME
Package
*
select
ID
NAME
1
PACKAGE 1 - 5 mbps for Home
3
PACKAGE 2 - 10 mbps for Home
2
PACKAGE 1+REAL_IP - 5 mbps for Home
5
PACKAGE 3 - 20 mbps for Home
4
PACKAGE 2+REAL_IP - 10 mbps for Home
8
PACKAGE 4 - 30 mbps for Home
6
PACKAGE 3+REAL_IP - 20 mbps for Home
9
PACKAGE 5 - 35 mbps for Home
7
PACKAGE 4+REAL_IP - 30 mbps for Home
10
PACKAGE 5+REAL_IP - 35 mbps for Home
12
PACKAGE 6 - 45 mbps for Home
11
PACKAGE 6+REAL_IP - 45 mbps for Home
13
PACKAGE 7 - 60 mbps for Home
18
SME PACKAGE 1 - 20 mbps for SME
14
PACKAGE 7+REAL_IP - 60 mbps for Home
17
SME PACKAGE 1+REAL_IP - 20 mbps for SME
15
PACKAGE 8 - 75 mbps for Home
19
SME PACKAGE 2 - 25 mbps for SME
20
SME PACKAGE 2+REAL_IP - 25 mbps for SME
22
SME PACKAGE 3 - 30 mbps for SME
21
SME PACKAGE 3+REAL_IP - 30 mbps for SME
16
PACKAGE 9 - 100 mbps for Home
!
MRC
OTC
Sub-Total
Discount (OTC)
Discount (MRC)
Net MRC
Net OTC
Total Net Payable
Verification Code
Code
*
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