Biznet Networks - Service Change Form: Customer Information
Biznet Networks - Service Change Form: Customer Information
Note: Please provide detailed information so we can provision the service faster. Please scan & email the Order
Form, or fax to +62-21-5700580.
Customer Information
Customer ID:
Previous Company Name/Customer Name: New Company Name/Customer Name:
Service Information
Previous Service Type: New Service Type:
Installation Information
Previous Installation Address - Node A: New Installation Address - Node A:
*for relocation
Payment Information
Previous Payment Type: New Payment Type:
Signature
PT Supra Primatama Nusantara - Service Change Form - Confidential Information 6/5/2015
Authorization
This service change form will only be valid if terms and Signature & Company Stamp Print Name:
conditions is attached.
Note:
1. Pelanggan setuju untuk tunduk dan terikat dengan
seluruh syarat dan ketentuan Layanan sesuai dengan
jenis layanan yang digunakan oleh Pelanggan;
2. Syarat dan Ketentuan dapat berubah sewaktu waktu
tanpa pemberitahuan terlebih dahulu kepada Date:
Pelanggan
Signature
PT Supra Primatama Nusantara - Service Change Form - Confidential Information 6/5/2015