Scribd
Upload
65 views2 pages

Trial Form - Biznet Dedicated Internet & DataComm

This document is a trial order form for Biznet Dedicated Internet or DataComm services. It requests information on installation locations, contact details, service details like bandwidth and type, and authorization for the trial order. The customer must attach a copy of their tax ID, passport, or other identification document.

Uploaded by

rezza ikramullah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
65 views2 pages

Trial Form - Biznet Dedicated Internet & DataComm

This document is a trial order form for Biznet Dedicated Internet or DataComm services. It requests information on installation locations, contact details, service details like bandwidth and type, and authorization for the trial order. The customer must attach a copy of their tax ID, passport, or other identification document.

Uploaded by

rezza ikramullah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 2

Trial Form Biznet Dedicated Internet / Biznet DataComm

Note: Please provide detailed information so we can provision the service faster. Please scan Sales Code
& email the Order Form, or fax to +62-21-5700580.
[ ]

Installation Information
Company Name/Customer Name:

Contact Phone : Contact Mobile Phone :

Contact Email :

Node A Node B
Building Name : Building Name :

Complex : Complex :
Street : Street :

District Name* : District Name* :


City : City :
Island Name : Island Name :
Province : Province :
Country : Country :
Postal Code : Postal Code :
* District Name equals to Kecamatan

Additional installation information


(Please specify in detail)

Installation and Technical Contact Person


Name : Mobile :

Phone : Email :

Service Information
Service : [ ] Biznet Dedicated Internet
Service Capacity:
[ ] 10 Mbps [ ] 35 Mbps [ ] 70 Mbps [ ] 150 Mbps [ ] 400 Mbps
[ ] 15 Mbps [ ] 40 Mbps [ ] 80 Mbps [ ] 175 Mbps [ ] 500 Mbps
[ ] 20 Mbps [ ] 45 Mbps [ ] 90 Mbps [ ] 200 Mbps [ ] 750 Mbps
[ ] 25 Mbps [ ] 50 Mbps [ ] 100 Mbps [ ] 250 Mbps [ ] 1 Gbps
[ ] 30 Mbps [ ] 60 Mbps [ ] 125 Mbps [ ] 300 Mbps
[ ]Others (please specify)

Signature
PT Supra Primatama Nusantara - Biznet Dedicated Internet / DataComm Trial Form - Confidential Information 5/8/2019
Service : [ ] Biznet DataComm
Service Capacity:
[ ] 1 Mbps [ ] 25 Mbps [ ] 250 Mbps [ ] 500 Mbps [ ] 10 Gbps
[ ] 2 Mbps [ ] 50 Mbps [ ] 90 Mbps [ ] 1 Gbps
[ ] 5 Mbps [ ] 75 Mbps [ ] 100 Mbps [ ] 2.5 Gbps
[ ] 10 Mbps [ ] 100 Mbps [ ] 250Gbps [ ] 5 Gbps
[ ]Others (please specify)

Service Type Biznet DataComm: [ ] P-to-P [ ] P-to-M [ ] M-to-M


We already applied Dual Stack system (IP v4 & v6) on IPv6 Addressing: Yes No
our network and we highly recommend you to add IPv6 to
your network.
Trial request date

Marketing Information
How do you know Biznet?
[ ] Newspaper: [ ] Biznet Website
[ ] Magazine: [ ] Search Engine
[ ] Radio: [ ] Referenced by friend/family/colleague
[ ] Billboard/Baliho [ ] Others:

Authorization
 We hereby confirm that the information above is true Signature & Company Stamp Print Name:
and agree to be bound by Biznet’s Terms and
Conditions which written on the proposal of
Dedicated Internet and we are the authorized to
signed the services order form.
Date:
 Biznet has the right to refuse this application without
any explanation

 Biznet’s Terms and Conditions may change at any


time without prior notice

 For credit card payment, we hereby authorize Biznet


to charge the credit card for service type we chose.

Please attach the following copies

[ ] Tax ID/NPWP for corporate customer, KTP/Passport/ID Card for personal customer

Signature
PT Supra Primatama Nusantara - Biznet Dedicated Internet / DataComm Trial Form - Confidential Information 5/8/2019

You might also like