Client Name*
Package* 25Mbps-RCN (500.00 - 25Mbps) 35Mbps-RCN (600.00 - 35Mbps) 50Mbps-RCN (900.00 - 50Mbps) 80Mbps-RCN (1000.00 - 80Mbps) Rack-6 (1200.00 - 100Mbps) 150Mbps-RCN (1500.00 - 150Mbps) 45Mbps-RCN (800.00 - 45Mbps) 40Mbps-RCN (700.00 - 40Mbps) 15Mbps-RCN (600.00 - 15mbps) AGG_80Mbps (1000.00 - 80Mbps) AGG_100Mbps (1200.00 - 100Mbps) AGG-15Mbps (600.00 - 15Mbps) AGG-80Mbps (1500.00 - 80Mbps) Repack-14 (1500.00 - 50)
Type of Connectivity* Shared Dedicated
Payment Method* Cash from Home Cash Office bKash Rocket iPay Card Bank Corporate
Signup Fee
Cell No*
Alternative Cell No 1
Address
Occupation
Email
National ID
Previous ISP
Feedback
Image
NID Front Side
NID Back Side
Agree With Our Conditions Yes No