Order Form

Customer Information

Company Name * Dinas Komunikasi dan Informatika Kabupaten Lumajang

Industry Segmentation * GOVERNMENT

Address * Jl. Alun Alun Utara No.7 Lumajang

Street Address

Kantor Bupati
Building Name

Lumajang Rogotrunan
District Subdistrict

Province * JAWA TIMUR

City 67316

City Others Lumajang

Diisi jika kota Anda tidak ada dalam daftar

Zipcode Other 67316

Diisi jika Kodepos Anda tidak ada dalam daftar

Salescode

Diisi oleh Sales Biznet

Billing Information

Address * Jl. Alun Alun Utara No.7

Street Address

Kantor Bupati
Building Name

Lumajang 67316
City Postal Code
 Order Form

Additional Address * Lumajang Rogotrunan

District Subdistrict

Jawa Timur Indonesia

State Country

Contact Information

Billing PIC Name * Mr. Eko Purwanto

Salutation Full Name

Billing Phone * +62 334881146

E.g: +62 21998XXX

Billing Mobile Phone * +62 82245886191

E.g: +62 8125578xxxx

Billing Primary Email * aptika.kominfo@lumajangkab.go.id

Billing Secondary Email kominfo@lumajangkab.go.id

Invoice Information

VAT/PPN * VAT A2 VAT A3 VAT A4

VAT A5

Please complete this section based on the tax regulations applied in your company.

W ith Holding Tax/PPh 23 * Yes No

Bill Cycle * Monthly Bimonthly Quarterly

Halfyearly Yearly
 Order Form

Term of Payment 14 Days

30 Days

60 Days

Other

Currency * IDR

USD

NPWP/Tax Information

NPW P/Tax ID * 00-117.099.2-625.000

Service Information

Service * Biznet Dedicated Internet

Biznet Educationnet

Biznet Healthnet

Biznet DataComm

Biznet Internet Exchange

Biznet Hospitality

Biznet Bandwidth on Demand

Biznet BGP

Biznet IP Address

Biznet Cross Connect

AS Number * 149676

Router IP Address * direct ptp address allocation from biznet

Routes to be Announced * 103.184.182.0/24

 Order Form

Routes to be Received * Full Route

Default Route

Other

Router Type * Opensource

Router Interface Card * Intel Gigabit 82580

Memory * 8 Gb

OS Version * Vyos 1.2.8 Crux

Service Notes Pada Isian Router Ip address, kami isikan

alokasi ip ptp dari biznet

Installation Information

Installation Address * Jl. Alun Alun Utara No.7

Street Address

Ruang Data Center Diskominfo

Building Name

Lumajang Rogotrunan
District Subdistrict

Province * JAWA TIMUR

City 67316

City Others Lumajang

Diisi jika kota Anda tidak ada dalam daftar

Zipcode Others 67316

Diisi jika Kodepos Anda tidak ada dalam daftar
 Order Form

Network Delivery * FTTH GPON FTTH EPON

METRO GPON METRO ETHERNET

Other

if available end to end

Technical Contact Person * Mr. M. Fendi Kurniawan

Salutation Full Name

Phone * +62 334881146

E.g: +62 21998XXX

Mobile * +62 82329382125

E.g: +62 8125578xxxx

Email * fendi@lumajangkab.go.id

Additional Installation Information * Please Inform to us before instalation and configuration

(Please specify in details)

Marketing Information

How do you know Biznet? * Social Media Biznet Website

Television/Radio Roadshow/Event

Banner Billboard/Baliho/Videotron

Referenced by friend/family/colleague Other

Marketing

Terms and Conditions Biznet BGP

Term s and Conditions

I accept the Terms and Conditions.
 Order Form

Please attach Tax ID/NPW P

NPWP-DISKOMINFO-LUMAJANG.jpeg

Signature *