Family Name* Last Name*
Japanese Katakana カタカナ (if possible)
Family Name Last Name
Language of your speak
Age *The subscriber shall be elder than 20 years old.
The exact address of the property which you wish to install the cable internet.
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 :
3rd choice :
Intend length of use the internet
1) Rental Wi-fi router YesNo
Please submit one or more ID.
PassportResidential Card (在留カード)Japanese Driver LisenceJapanese Health Insurance card
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.