Application for connection

Address:

Indicate the street:

House

Housing

Apartment

Information about you:

Surname:

Name:

Middle name:

Passport data:

E-mail:

Contact number

Additional number:

Additional Information:

Connection time convenient for you:

Desired rate:

The presence of a network card:

Yes

I do not know

Installing a router:

Need

Need not

I do not know

Antivirus Installation:

Router Setup:

Now Internet access through:

How did you hear about us (source):

Enter the username / address / contract number of a friend:

Now Internet access through:

I agree to the processing of personal data.

Address:

Indicate the street:

House

Housing

Office

Company Name:

E-mail:

Contact number

Additional number:

Additional Information:

Connection time convenient for you:

Desired rate:

The presence of a network card:

Yes

I do not know

Installing a router:

Need

Need not

I do not know

Antivirus Installation:

Router Setup:

Now Internet access through:

How did you hear about us (source):

Enter the username / address / contract number of a friend:

Now Internet access through:

I agree to the processing of personal data.