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.
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.