Nasionet Personal ISDN Dial-up Account Order Form

1.Date (mm/dd/yy):
2.Name of Company/Person :
3.Address :
4.Post Code :
5.City :
6.State :
7.Tel:
8.Fax:
9.E-mail Address :
10.Contact Person:
11.Designation :
12.Package of service required :
13.Payment Method :
* for credit card payment, kindly contact the admin office for a seperate payment form.




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Main Office
802C, Executive Suite, Block B
Kelana Business Centre,
97, Jalan SS7/2,
Kelana Jaya,
47301 Petaling Jaya.
Tel : 603-582 1008
Fax : 603-582 0388
Network Centre
403, 2nd Floor, Block A,
Glomac Business Centre,
10, Jalan SS6/1,
Kelana Jaya,
47301 Petaling Jaya.
Tel : 603-704 4469,704 7008
Fax : 603-704 7002


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