EmailMe Form - UNiFi Application form

Required Unifi package : *
*It is possible to apply BIZ (business) package for residential
*For BIZ package only :
Company registration number : 00231414-T
*Company registered name:
ABC SDN BHD
Full name as per IC : *
NEW IC No : *
(example : 200580081889)
Handphone No : *
example : 0123456789
Email : *
Must be a valid email address
Full address : *
example : 24, Jalan Setiakasih 4, Taman Damansara 2
Postcode : *
example : 52100
City : *
Example : Cheras
Property type : *
Landed
High Rise
Current Streamyx user : *
Yes
No
If yes, streamyx userid :
Example : streamyxac1
Telephone number attached with streamyx :
Example : 0322221111
Termination :
Instruct for termination AFTER unifi is installed
Installation schedule : *
Anytime (I want soonest installation)
Weekend only
Weekday only (highrise properties)
*For highrise property TM do not allow weekend installation.
IC scanned copy :
Scanned copy of IC front and back, IC numbers must be visible.
Note :
Any instruction/remarks, do input here.