MAHANAGAR TELEPHONE NIGAM LTD. MUMBAI

ORDER FORM FOR MTNL-INTERNET ADDITIONAL SERVICES

I wish to subscribe to MTNL Internet Additional Services as per details given below :
PERSONAL / COMPANY DETAILS :
(a) Name : __________________________________________
(b) Address for
Correspondence : __________________________________________
(c) Billing address :___________________________________________
(d) Contact Person : __________________________________________
(i) Tel.No. :___________________________________________
(ii) Fax No. :___________________________________________
PRESENT ACCOUNT DETAILS :
(a) Customer Code :
(b) User Name :
(c) Account Type (PSTN / ISDN ) :
ADDITIONAL SERVICES REQUIRED :
(a) Fixed IP Address : (Yes/No)
(One Fixed IP Address is provided
per dial-up account.)
(b) Change in Login-id : ( choice )
(c) Additional Mail Memory : (MB)
(d) Additional Personal Web Space : (MB)
(e) Additional E Mail Address :
COUNTER FOIL – (TO BE FILLED BY MTNL ONLY)
Customer Code : _____________________
PAID RECEIPT NO. _____________________DATED__________________AMOUNT Rs.
SERVICES PROVIDED : CO-INTERNET MTNL, MUMBAI
Note : 1. All D/D’s to be drawn in favour of MTNL, Mumbai.
2. The form duly filled should be submitted to CO (Internet) o/o AGM (C-PW), Ground
Floor, Telephone Bldg., C.Rai Marg, Fort, Mumbai – 1,
3. Order form will be accepted between 10:30 AM to 1:30 PM on all working days.