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• Title
  -Select-MrMrsMissMs.DrProfRev

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• Name
  
  FirstLast

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• Company Name
  

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• Home Phone Number
  

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• Mobile Phone Number
  

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• Email
  

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• Date of birth
  
  dd-MMM-yyyy

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• Drivers License/Passport/Proof of Age
  

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• Installation Details

   

• Site Installation Contact
  
  
  Same as primary contact
  
  
  Different Contact

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• Contact Name

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  Enter the first and last name of the contact person for site installation.

• Installation Address
  
  Street Address
  Address Line 2
  City
  State/Region/Province
  Postal / Zip Code
  
  -Select-Åland IslandsAfghanistanAkrotiriAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAshmore and Cartier IslandsAustraliaAustriaAzerbaijanBahrainBangladeshBarbadosBassas Da IndiaBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandClipperton IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCoral Sea IslandsCosta RicaCote D’IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the CongoDenmarkDhekeliaDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaEuropa IslandFalkland Islands (Islas Malvinas)Faroe IslandsFederated States of MicronesiaFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern and Antarctic LandsGabonGaza StripGeorgiaGermanyGhanaGibraltarGlorioso IslandsGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-bissauGuyanaHaitiHeard Island and Mcdonald IslandsHoly See (Vatican City)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJan MayenJapanJerseyJordanJuan De Nova IslandKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNavassa IslandNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParacel IslandsParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRepublic of the CongoReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSpratly IslandsSri LankaSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandThe BahamasThe GambiaTimor-lesteTogoTokelauTongaTrinidad and TobagoTromelin IslandTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin IslandsWake IslandWallis and FutunaWest BankWestern SaharaYemenZambiaZimbabwe
  Country
  

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• Billing Details

   

• Preferred Payment Method
  
  
  
  

  

  Direct Debit

  
  
  
  
  

  

  Pay as you go

  
  

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• Are you an existing IPSTAR customer?
  
  
  
  Yes
  
  
  No

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• Who is your current ISP (Internet Service Provider)?
  

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• How did you hear about IPSTAR?
  
  -Select-IPSTAR BrochureIPSTAR WebsiteGoogle/Other Search EngineSocial MediaFriends/FamilyRadioTVEventOthers

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• Referrer (Name or Customer #)
  

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• Please enter your promo code here:
  

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• Additional Comments
  

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  Add your comments about your home address, second dwelling and NTD number or any other special requirements you may have.

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• Agreement

   

• Your Plan Summary

   

  Plan: Medium 100GB

  Plan: Unlimited

  Speed: 12/1 Mbps

  Speed: 25/5 Mbps

  Speed: 50/20 Mbps

  Term: 1 Month

  Term: 12 Months

  Term: 24 Months

  Router: No router

  Router: Basic Wi-Fi Router

  Router: Standard Wi-Fi Router

  Router: Advanced Wi-Fi Router

  Router: Premium Wi-Fi Router

  Total cost: $

  65.00

  p/m

  + $

  90

  router cost

  + $

  99

  set up fee

• Terms and Conditions
  *
  

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  Purto offendit vituperata ut quo, et vix mucius epicurei inimicus. Quo in elitr torquatos. Tincidunt incorrupte percipitur quo no, pro ei vocent tritani senserit. His ut errem simul prompta, eu rebum repudiandae cum. Qui perfecto honestatis te. Mei ei solum reprehendunt, ius et timeam quaeque numquam.
  Purto offendit vituperata ut quo, et vix mucius epicurei inimicus. Quo in elitr torquatos. Tincidunt incorrupte percipitur quo no, pro ei vocent tritani senserit. His ut errem simul prompta, eu rebum repudiandae cum. Qui perfecto honestatis te. Mei ei solum reprehendunt, ius et timeam quaeque numquam.
  Purto offendit vituperata ut quo, et vix mucius epicurei inimicus. Quo in elitr torquatos. Tincidunt incorrupte percipitur quo no, pro ei vocent tritani senserit. His ut errem simul prompta, eu rebum repudiandae cum. Qui perfecto honestatis te. Mei ei solum reprehendunt, ius et timeam quaeque numquam.

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  I accept the Terms and Conditions.

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