Professional Documents
Culture Documents
Internet Registration Form
Internet Registration Form
■ Company Information
Subscriber ID (filled by Moratelindo) Existing Subscriber ID (filled by Moratelindo)
Name of Company
Correspondence Address
Phone Ext Mobile Fax
Name of Authorized Officer Designation
ID Number/Passport
Tax Registration Number
Name of Director
■ Billing Information
Name of Finance Officer
Billing Address
Phone Ext Mobile Fax
■ Requirement Information
Link Destination Payment in X IDR USD
We hereby confirm that the foregoing information herein given to be true and correct, and will follow the Terms and Conditions Internet Subscription.
We agree to be bound by the Terms and Conditions Internet Subscription as attached with this form.
Subscriber Approval By
PT. Mora Telematika Indonesia
Materai 6000 (Moratelindo)
. . . .
Date of Received : . Date of Received : .