Clickers Subang Jaya SS15

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  1.0  Type Of Application
Type of Application  
Packages


* Save RM88 for self installation

For upgrade or downgrade, please state existing Login ID     
(Minimum 3 characters, maximum 8 characters)

Note:

  1. One-time Service Activation Fee of RM75 and Installation Fee of RM88 applicable to all packages unless otherwise stated.
  2. Email Account Allocation: Home Package (1), Enterprise/Corporate packages (3).
  3. *IP Address Allocation: Enterprise (1 fixed IP), Corporate (5 fixed IP).

  2.0  Details of Home Applicant
Name of Applicant
(As per NRIC/Passport):
Installation Address:
City:
Postcode:
State:
Country:
Tel. No.
(Where tmnet streamyx is to be connected):
Mobile No.:
Email:
NRIC:
Passport No.:
Date of Birth:  (DD/MM/YYYY)
Gender:
Preferred access Login ID
(Min. 3 characters, max. 8 characters)
 1.  2.  3. 
Preferred email Login ID
(Min. 3 characters, max. 8 characters)
(xxx@streamyx.com)
 1.  2.  3. 

  4.0  Invoicing and Billing Information

Is the billing name and address the same as in 2.0 or 3.0 ?
(If yes, only pick preferred billing method)


  7.0  For Agent Use Only

Agent Id:  

Please submit only if you agree with the Terms & Conditions

 


Proxus Communications Sdn Bhd 
No. 81 Jalan SS15/5A
47600 Subang Jaya,
Selangor D.E.

Tel: +603 5638 8098, +603 5638 9098
Fax: +603 5638 3980