| 1. |
Subscriber Name (Individual/Organization) |
|
| 2. |
Authorized Person's Name |
|
| 3. |
Contact Person's NID |
|
| 4. |
Connection Address (Area) |
House No, floor, Road No,Area, land mark,upozila, zila |
| 5. |
Billing Address |
House No, floor, Road No,Area, land mark,upozila, zila |
| 6. |
Connection Typ |
|
| 7. |
Type of User |
|
| 8. |
Type of Account |
|
| 9. |
Required Item |
|
| 10. |
Preferred E-mail Address |
|
| 11. |
Bandwidth |
|
| 12. |
No of IP Address |
|
| 13. |
Technical Requirements |
|
| 14. |
Operating System |
|
| 15. |
Upload NID Card |
|
| 16. |
Customer Photo Upload / Capture |
|
| 16. |
Application Signature |
|
| 17. |
Date |
|