Payment Form

Multinet ( Udaipur) Private Limited
311, Mid Town Business Centre, Station Road, Udaipole, Udaipur (Raj.)

Subscription Form for Wired / Wireless Internet Connection

A. Customer Particulars

1. Title/Name of the Customer (Last name First) Company/Firm/Organization *

2. Address *

E-mail Address *
Date of Birth (dd/mm/yy)
Subscription Type: (Tick any one)	Monthly Annual
Plan Opted (See Instructions)

8. Internet Connection Type

9. In case of BPO/Cal l Centre/NOC/OSP, kindl y attach proof of registration with DOT :

Applicable Not Applicable DOT Reg. No

ADDITIONAL SERVICES REQUIRED

ii. No. of Fixed IP Addresses:

C. Customer Premises equipment (CPE) details: (See Instruction no. 9 )

i. Whether CPE (Router) is required from Multinet If yes, specify CPE type	Applicable Not Applicable Normal Wireless
ii. Ethernet (RJ 45) Port Availability on Customer’s PC Hub	Yes No
iii. In case of (i) above Customer to use his own CPE and ensure compatibility (See Instruction of General Instructions)
Please specify your CPE Router Specification (Type Make & Model No)

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In case the PC does not have required Software and Hardware, the same is to be got installed by customer at his own cost from PC vendor/ supplier

Declaration

	I have read the CPE requirements and all the Terms & Conditions as specified in ANNEX - I of Subscription Form for Internet connection. I accept all the Terms & Conditions as specified in ANNEX - I of Subscription Form for Internet connection.
	Terms and Conditions (Click Here)