Residential Application

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

@foreach($data as $a)
@if ($a['subscription']==24 && ($a['package']=='50Mbps' || $a['package']=='100Mbps' || $a['package']=='300Mbps' || $a['package']=='500Mbps')) @endif
Application Type {{$a['application']}}
Package City Broadband Residential {{$a['package']}}
Promotion RM10 off for 24 months
Contract Term {{$a['subscription']}} Months
Preferred Installation Date {{$a['thedate']}}

Home Voice Plan {{$a['voice']}}

Full Name {{$a['name']}}
MyKad/Passport {{$a['nric_passport']}}
Gender {{ucfirst($a['gender'])}}
Nationality {{$a['citizenship']}}
Primary Phone Number {{$a['contact_primary']}}
Secondary Phone Number {{$a['contact_secondary']}}
Email Address {{$a['email']}}

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

@if($a['package']!='1Gbps' && $a['subscription']=='24')
Promotion: RM10 off for 24 months @endif @if($a['package']!='1Gbps' && $a['subscription']=='24') @else @endif @if($a['voice']=='Yes') @endif
Description Price exclude ST With ST 6%
City Broadband Residential - {{$a['package']}}RM{{ $product->retail_price }} RM{{ $promo_price}} RM{{ $promo_st }}RM{{ $product->retail_price }} RM{{ $gst }}
Voice Home Plan RM20 RM21.20
Total Charges RM{{ $total_monthly }}

Description Price exclude ST With ST 6%
One Time Charges RM{{ $otc }} RM{{ $otc_st }}
Deposit RM{{ $deposit}}
Total Charges RM{{ $upfront_total }}
All upfront charges will need to be paid prior installation. You will receive an email once your application has been processed.

Declaration and Signature

Upload Documents

Acceptable formats: jpg , jpeg , png
After you save your signature, the submit button will automatic be display.
@endforeach