EmailMe Form - YES APPLICATION FORM

SELECT SERVICE TYPE *

POSTPAID

PREPAID

SELECT DEVICE *

GO

HUDDLE

ZOOM

Terms & Conditions:
- Free Go Dongle with a commitment of 12 month on any plan.
- Free Huddle or Zoom only valid with a commitment of 24 months.
Device upfront payment applies and will be rebated over 20 months
- Speed claims represent the capabilities of the network under an ideal situation.
Real world results may vary.
For full details on all terms and conditions please email mycomtech39@yahoo.com

PACKAGES *

CUSTOMER DETAILS

IDENTIFICATION TYPE *

MALAYSIAN

NON-MALAYSIAN

FULL NAME *

As per IC

NRIC/ IC NUMBER *

DATE OF BIRTH *

DD / MM / YYYY

GENDER

MALE

FEMALE

RACE

MALAY

CHINESE

INDIAN

Other

EMAIL ADDRESS *

CONFIRM EMAIL

HOME NUMBER

Example: 04-1234567

MOBILE NUMBER *

Example: 012-1234567

ADDRESS

Mycom Technology Centre

Customer Service: 012 576 8010
Tel/Faks: 04 917 4189

Any Enquiry, Please Write Down:-
(Alternatively, you can write to our facebook account: http://www.facebook.com/mycomtc or email us on a_mycom@yahoo.com)