REDtone HOME+ Online Form - D'Secret Service Order*New ApplicationUpgradeRelocationTerminationCUSTOMER INFORMATIONTitle:Mr.Mrs.Ms.OthersOthers:*Full Name (as per NRIC):*Customer Account:NRIC/Passport:*Correspondence Address:*Postcode:*City/State:*Email:* Telephone No.:*Mobile No.:*INSTALLATION ADDRESSSelect Area:*D'Secret GardenAddress:*Postcode:*City/State:*Billing Email: TYPE OF APPLICATIONS AND PACKAGESPackages: 5Mbps - RM 139/month 5Mbps bandwidth, 1 Fixed line number, Devices includes Cordless phone and Residential Gateway (RG), Dynamic IP 10Mbps - RM 189/month 10Mbps bandwidth, 1 Fixed line number, Devices includes Cordless phone and Residential Gateway (RG), Dynamic IP 20Mbps - RM 279/month 20Mbps bandwidth, 1 Fixed line number, Devices includes Cordless phone and Residential Gateway (RG), Dynamic IP Minimum Subscription Period:*24-MonthsBilling Period in Advance (Billing Frequency):*MonthlyQuarterlyHalf YearlyYearlyInstallaton fee RM200 One (1) month deposit fee, One (1) month advance payment; and charges for data usage (pro-rated) and value added services (if any) incurred after the installation date will be included in the first bill. All payment to be made via myREDtoneAUTO-PAYMENT VIA CREDIT CARDGuidelines Please ensure that the credit card holder’s and REDtone Telecommunications Sdn. Bhd. registered customer’s name are the same. Application must be supported by: - Copy of credit card and copy of NRIC/Passport. Application via 3rd party’s credit card must be supported by: - Authorization letter, copy of credit card, copy of NRIC/Passport and latest credit card statement. Please allow 14 days for REDtone Telecommunications Sdn. Bhd. to receive and process the application before using the Auto Debit service. Please advice on all future changes to the card particulars (card number / expiry dates) by faxing to 03-8073 2128 or send email to email@example.com. Please view Terms and Conditions Card member’s Name as on Credit Card:Credit Card No:Issuing Bank:Card Expiry Date:Card Expiry Date:Credit Card type:VisaMasterCardNRIC No.:* Drop files here or Please enclose a photocopy of your NRIC (front and Back).Credit Card: Drop files here or Please enclose a photocopy of Card Holder's Credit Card.Auto-payment using third party Credit Card must submit:Authorization Letter/ NRIC: Drop files here or I hereby authorise REDtone Telecommunications Sdn. Bhd. to charge the outstanding amount due for such amount advised by REDtone Telecommunications Sdn Bhd from time to time to my Credit Card indicated above. I accept, agree and confirm that this authorisation is governed by the Terms & Conditions stated overleaf and that all information provided is correct. I further agree that my Credit Card shall be charged on the 15th day of every month and that REDtone Telecommunications Sdn Bhd may at its sole discretion change this billing date. Shall the date fall on a non-working day or a public holiday, the charges will be billed to my credit card account on the next working day.Consent* Click to accept the Terms and ConditionsNameThis field is for validation purposes and should be left unchanged.