Business Application

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

@foreach($data as $a)
Preview
Type Application {{$a['application']}}
Residential Package 10Mbps
Contract Term {{$a['subscription']}} Months
Prefered Appointment Date {{$a['thedate']}}

Subscribe for Voice {{$a['voice']}}

Company Name {{$a['company_name']}}
Business Reg.No {{$a['company_register']}}
Company Contact No. {{$a['company_number']}}
Company Fax No. {{$a['company_fax']}}

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']}}

Address {{$a['caddress']}}
Postcode {{$a['postcode']}}
City {{$a['ccity']}}
State {{$a['cstate']}}

DescriptionPrice excl. STWith ST (6%)
Broadband Fee 149 157.94
Deposit 149
OTC 0.0
Total Charges 306.94

Declaration and Signature

@endforeach