Internet Application

日本語版はこちら

★Applicant's Information
Full Name

     Alphabet
    Family Name*      Last Name*
    Japanese Katakana カタカナ (if possible)
    Family Name         Last Name  
Email *
  1.         2.
Phone Number*
  1.       2.
Skype ID
 
LINE ID
 
Nationality
 
Language of your speak
  EnglishJapaneseOther language
Occupation
 
Age     *The subscriber shall be elder than 20 years old.
 

 
★Property Information
  The exact address of the property which you wish to install the cable internet.
  Address*
 
  Buiding Name*
    Room Number*
  Buiding type* Condo(own)Apartment(rental)House (own)House (rental)Other
 

★Wishing Date for installation work for internet starting *
  What date do you prefer to install the internet into your home?
  The wishing date should be the date of after two weeks or later.

    1st choice : ( yyyy-mm-dd )
    2nd choice : ( yyyy-mm-dd )
    3rd choice : ( yyyy-mm-dd )

  Intend length of use the internet
      about years

 
★Option
  1) Rental Wi-fi router YesNo

Message

 

Identification

Please submit one or more ID.
 PassportResidential Card (在留カード)Japanese Driver LisenceJapanese Health Insurance card
     

 

Confirmation

I have an intend to continue the contract for more than one year.
I understand the cancellation policy and I agree that I may have to pay additional cancellation penalty when I cancel the contract in most case.