EmailMe Form - Application Form for Streamyx BUSINESS

Company Name : *

Company Registration No : *

Are this office have telephone line? : *

YES

NO

If YES, what is the number :

Are you want use this telephone line for Streamyx ?:

YES (I want use this telephone line for Streamyx)

NO (I want add new telephone line for Streamyx)

Note : If you have telephone line and want use this line for streamyx, applicant name must same with telephone-line register name.

Package Information

Streamyx BIZ Package : *

Please refer http://telecomninterestonlinebm.blogspot.com/ for the packages.

(Only alphanumeric allowed, please do not insert symbol such as "-", "." etc).

Preffered LoginID 1: *

5-8 Characters. xxxxx@streamyx.com

Preffered LoginID 1: *

5-8 Characters. xxxxx@streamyx.com

Preffered LoginID 1: *

5-8 Characters. xxxxx@streamyx.com

(Only alphanumeric allowed, please do not insert symbol)
Example : company.com.my

Choose domain *

Preferred Domain 1: *

5-8 Characters. (xxxxx.domain)

Preferred Domain 2: *

5-8 Characters. (xxxxx.domain)

Preferred Domain 3: *

5-8 Characters. (xxxxx.domain)

Applicant Information

Name of Business Owner : *

* must same with NRIC

Applicant IC No : *

(Example: 721010145243)

Applicant Old IC No : *

(This is required if applicant born in 1977 or before 1977)

Office Number : *

Mobile Number : *

Contact Email : *

Installation Address: *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Please fill (-) for empty space. Must same with TNB address bill.

Please upload your document requirement below: in .jpg or .pdf . Only for 1MB size.

Copy of Business Owner IC : *

Copy of Companies Commision Malaysia (SSM) - business registration : *

Package Information

(Only alphanumeric allowed, please do not insert symbol) Example : company.com.my

Applicant Information

Please upload your document requirement below: in .jpg or .pdf . Only for 1MB size.

(Only alphanumeric allowed, please do not insert symbol)
Example : company.com.my