Client Name*
Package* Silver (500.00 - 10 Mb) 12 Mbps (600.00 - 12 Mb) 15 Mbps (700.00 - 15 Mbps) 20 Mbps (800.00 - 20 Mbps) 30MB (1000.00 - 30 Mbps) 40 Mbps (1200.00 - 40 Mbps) DOMINANT+ (1400.00 - 50MB) valiant (2000.00 - 200MB)
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