Customer Registration Form (Broadband Internet)
for All
(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
Minor - 8 mbps for Home
2
Junior - 10 mbps for Home
3
Learner - 15 mbps for Home
4
Basic - 20 mbps for Home
5
Primary - 35 mbps for Home
6
Dominant - 45 mbps for Home
7
Confident - 60 mbps for Home
8
Positive - 75 mbps for Home
9
Advance - 90 mbps for Home
10
Progressive - 120 mbps for Home
11
Spark - 30 mbps for SME
12
Spark Lite - 30 mbps for SME
13
Flame Lite - 40 mbps for SME
14
Flame - 40 mbps for SME
15
Blaze - 50 mbps for SME
16
Blaze Lite - 50 mbps for SME
!
MRC
OTC
Sub-Total
Discount (OTC)
Discount (MRC)
Net MRC
Net OTC
Total Net Payable
Verification Code
Code
*
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