FIBRE OPTIC COMMUNICATIONS

AUTO DEBIT APPLICATION FORM

Gone are the days of waiting in lengthy queues to make your payments.The superfast days of the Auto
Debit are here!
For your convenience, you can now make payments via Auto Debit through your VISA, Mastercard,
AMEX and Diners card. Just part of our ever improving service towards making life easier for you.
To make things even simpler, you can now avail of two easy ways to register for Auto Debit. Simply ll
in the attached form and send it to us via mail, fax or email.

Mail

TIME dotCom Berhad

Auto Debit Unit, Credit Management Department
No. 14, Jalan Majistret U1/26, Hicom Glenmarie Industrial Park,
40150 Shah Alam

Fax

Email

03 - 5032 6351

autodebit@time.com.

DETAIL OF APPLICATION (as in NRIC/Passport)

Mr.

Ms.

Title

Full Name
New I.C No

OLD I.C No

Business Registration No.

Customer Contact No.

Mobile

House/Office

I would like to make auto debit payment for my TIME bills via
Master Card

Visa

AMEX

Diners Club

Credit/Charge Card No.

Expiry Date

Name
(As it appears on your credit/charge card)
Card Issued By
(Name of bank/Issuer)
Please fill in the following details for Auto Debit Payment (For more than 3 account numbers, please attach a separate listing)
TT dotCom Sdn Bhd Account Nos
1
2
3
I have read and fully understood the terms for the Auto Debit services. I accept and agree to be bound by all terms and conditions of the
Auto Debit services as stipulated in the customer service order agreement.
I also confirm that all the information above is accurate.

Signature
Terms:

Date
A. To apply for Auto Debit Services, customers must attach a copy of their credit/charge card (both sides).
B. For application via 3rd party's credit/change card, application must be supported by Authorisation Letter from card owner.
C. Please ensure both account number and card number are correct.