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BCS Net Isp Form

User Details

Name:

Father’s Name:

Occupation:

Organization/Institute / Company:

Contact No:

Alternate Contact

Connection Address:

Floor:

Right

Left

Front

Back

E-mail:

Technical Details

Account Types

Individual

Corporate

Package:

Marketing Person:

Technical Team:

ONU Mac Address:

Google L/L:

User Name:

Password:

OLT No:

PON:

Main Splitter:

1st sub:

2nd sub:

Core

Type 4CF

Fiber Used

Type 2CF

Fiber Used

Billing Details

Connection fee(Non refundable)

Security deposit (refundable)

Monthly Bill

Billing Date:

Total Amount BDT

Do you have your Own ONU?

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Choose ONU Front Photo

Upload ONU Back Photo

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Special Note:

Uploads

Upload Your Photo

Choose your photo

Upload Your Location Photo

Choose your location photo

Upload NID Front

Choose your NID front

Upload NID Back

Choose your NID back

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