Biznet | Service Change Form

SERVICE CHANGE INFORMATION

Customer ID *

Customer ID : E.g: 5500XXXXXXX

Contract Number *

Contract Number : E.g: 000000786XXX

Service Change Type *

Biznet Service *

Billing Account Number *

Billing number : E.g: 1000XXXXXXX

BIll Cycle *

New Biznet Service *

Biznet Home Category Service*

Region *

Biznet Home Service *

Biznet Metronet Service *

Biznet Dedicated Internet Service Capacity *

Biznet Educationnet Service Capacity *

Biznet DataComm Service Capacity *

Biznet Internet Exchange Service Capacity *

Biznet Hospitality Service Capacity *

Service Fee *

Network Delivery

Relocation Fee

Relocation Date

Network Delivery Node B

CONTACT DETAIL

ID Country *

Fetching data

ID Type *

Fetching data

ID Number *

Please attach ID*

First Name *

Last Name *

Select Gender *

Date Of Birth

Company Name/Customer Name *

COMMUNICATION DETAIL

Mobile Number *

Home Number

Email *

Preferred Language

Fetching data

BILLING ADDRESS B2B

Find Address

Building/Complex Name

Street 1 *

Street 2 (If Any)

Street 3 (If Any)

Country

State

City

District

Sub District

Postal Code

INSTALLATION ADDRESS

INSTALLATION NODE A ADDRESS

Find Address / Property

Please follow the address structure examples as written below and match it as you type or input the data.

1. Building & Apartment / Property Name

- APARTEMEN JEMBER TOWN SQUARE - TOWER B LT 1 UNIT 15

- APARTEMEN JEMBER TOWN SQUARE - UNIT A12

- DREAMLAND CLUSTER KAV 17

- BANK JATIM CABANK BANYUWANGI CABANG INDUK

2. Main Street

- JL JOYOBOYO NO 635

- JL A YANI GG 1 NO 1

- JL KARANG INDAH TIMUR GG SEJAHTERA BLOK B NO 1

- JL ALAMANDA PREMIER - BLOK A NO 3B

3. Complex Name / Store

- PERUMAHAN JAYALAND PURI SURYA JAYA TERRACE - BLOK CC3 NO 26

- PERUMAHAN WISMA KATANG GG 2 NO A12

- PERUMAHAN LATIFA BOULEVARD NO 15

- PERUMAHAN BUMI LAMONGAN RAYA

Address 1

Sub District

Address 2

District

Address 3

City

Postal Code

Address 4

State

Country

Address 5

INSTALLATION NODE B ADDRESS

Set Equal To Installation

Find Address / Property

Address 1

Sub District

Address 2

District

Address 3

City

Postal Code

Address 4

State

Country

Address 5

IDENTIFIKASI TAX ID ADDRES

Set Equal To Installation

Find Address / Property

Address 1

Sub District

Fetching data

Address 2

District

Fetching data

Address 3

City

Fetching data

Postal Code

Address 4

State

Fetching data

Country

Fetching data

Address 5

BILLING ADDRESS

Set Equal To Installation

Find Address / Property

Address 1

Sub District

Fetching data

Address 2

District

Fetching data

Address 3

City

Fetching data

Postal Code

Address 4

State

Fetching data

Country

Fetching data

COMMUNICATION BILLING DETAIL

First Name *

Last Name *

Mobile Number *

Home Number

Email *

SIGNATURE

Sales Code*

Notes

Signature*

Service Change Information

SERVICE CHANGE INFORMATION

CONTACT DETAIL

Fetching data

Fetching data

COMMUNICATION DETAIL

Fetching data

BILLING ADDRESS B2B

INSTALLATION ADDRESS

INSTALLATION NODE A ADDRESS

1. Building & Apartment / Property Name

2. Main Street

3. Complex Name / Store

INSTALLATION NODE B ADDRESS

IDENTIFIKASI TAX ID ADDRES

Fetching data

Fetching data

Fetching data

Fetching data

Fetching data

BILLING ADDRESS

Fetching data

Fetching data

Fetching data

Fetching data

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COMMUNICATION BILLING DETAIL

SIGNATURE