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STEP
1
Application Form and Plan Details
SELECTED PLAN and Speed:
Please SELECT:
new! CONVERGE FiberX 1500 Unlimited 300mbps Monthly Internet Bill P1,625 for 24 months
new! CONVERGE FiberX 2000 Unlimited 500mbps Monthly Internet Bill P2,125 for 24 months
new! CONVERGE FiberX 2500 Unlimited 700mbps Monthly Internet Bill P2,625 for 24 months
new! CONVERGE FiberX 3500 Unlimited 1000mbps Monthly Internet Bill P3,500 for 24 months
new! CONVERGE FiberX 1250 Unlimited 100mbps Monthly Internet Bill P1,375 for 24 months
CONVERGE BIDA FIBER new update! (The initial cash out is now at P1,776 security deposit and 1 month advance) - Monthly Internet Bill 988 for 18 months (35mbps for a total of 6 WiFi devices can be connected, ports connected to LAN are disabled)
1. First Name:
2. Middle Name:
3. Last Name:
4. Date of Birth:
5. Gender:
6. Mother's Maiden Name: First name, Middle name, Last name
7. Civil Status:
8. Name of Husband or Wife (if married): First name, Middle name, Last name
9. Citizenship:
10. Primary E-mail Address:
10 a. Secondary E-mail Address:
11. Primary Mobile No:
12. Secondary Mobile No:
13. VERY IMPORTANT Please indicate your COMPLETE ADDRESS:
13 a. Home Ownership:
Owned
Living with Relatives
Mortgage
Rented
13 b. Years of Residency:
14. VERY IMPORTANT your House number and Purok ***
15. NEAREST Landmark:
16. Exact Plan You are Looking For and Customer Notes:
SUBMIT NOW!
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