Business Application

Please follow the steps below to complete your application. We will get back to you shortly.

@foreach($data as $a)

Subscription Details

Application Type	{{$a['application']}}
Package	City Broadband Business {{$a['package']}}
Contract Term	{{$a['subscription']}} Months
Preferred Installation Date	{{$a['thedate']}}

Add-On(s) @if($a['package'] != '50Mbps') @else @endif @if($a['ip'] == '') @else @endif

Business Voice Plan and Dect Phone	Free	{{$a['voice']}}
Fixed IP	No	{{$a['ip']}}

Personal Details

Full Name	{{$a['full_name']}}
MyKad/Passport	{{$a['nric_passport']}}
Designation	{{$a['designation']}}
Primary Phone Number	{{$a['contact_primary']}}
Secondary Phone Number	{{$a['contact_secondary']}}
Email Address	{{$a['email']}}

Service Installation Address

Unit Number	{{$a['unit']}}
Building	{{$coverage->building_name}}
Street	{{ucwords($a['street'])}}
Postcode	{{$coverage->postcode}}
City	{{$coverage->city}}
State	{{$coverage->state}}

Monthly Recurring Charges @if($a['voice']=='Yes') @endif @if($a['ip'] == '1 Fixed IP RM200/1P/Month') @endif

Description	Price exclude ST	Total*
City Broadband Business - {{$a['package']}}	RM{{ $product->retail_price }}	RM{{ $gst }}
Business Voice Plan	RM20	RM21.20
Fixed IP	RM {{$a['ip_fee']}}	RM {{$a['ip_tax']}}
Total Charges		RM{{ $total_monthly }}

*Price subject to 6% Service Tax (if applicable).
@if ($upfront_total != '0')

Upfront Charges @if ($otc_st != '0') @endif @if ($deposit != '0') @endif

Description	Price exclude ST	Total*
One Time Charges	RM {{ $otc }}	RM {{ $otc_st }}
Deposit		RM {{ $deposit}}
Total Charges		RM{{ $upfront_total }}

*Price subject to 6% Service Tax (if applicable).
All upfront charges will need to be paid prior installation. You will receive an email once your application has been processed. @endif

Declaration and Signature

Document & Declaration *

Photocopy of MyKad (front and back) or passport for Non-Malaysian (minimum 12 months validity)

Local Registered Company
Photocopy of Form 9/Form 13/Notice of Registration (Section 15)/Certificate of Incorporation (Section 17)/Section 28/Certificateof Practice issued by the relevant authority (NGO/Association /Cooperative)
Foreign Registered Company
Form 79/Form 80/Form 80a/Form 83/Form 83a/Section 562(1)

I hereby consent to the collection, use, disclosure of my personal information in accordance with the Privacy Policy available on www.citybroadband.my.

I hereby declare that the above information, documents, and any appendices attached are true and valid. I have read and understood the contents of this form and agreed to be bound by Terms & Condition as stated on the next page of this form which accompany the subscription of product(s) and/ or service(s). Allo Technology Sdn Bhd reserve the rights to refuse any application at any given time should any of the information is incorrect.

Upload Documents

Acceptable formats: jpg , jpeg , png, pdf

MyKad / Passport (Front) *

MyKad/ Passport (Back)*

Local Registered Company
Form 9/Form 13/Notice of Registration (Section 15)/Certificate of Incorporation (Section 17)/Section 28/Certificateof Practice issued by the relevant authority (NGO/Association /Cooperative) *
Foreign Registered Company
Form 79/Form 80/Form 80a/Form 83/Form 83a/Section 562(1) *

@endforeach