Customer Application Form
Service Details
SPEED
60 MBPS
80 MBPS
100 MBPS
200 MBPS
VALIDITY
6 MONTHS
9 MONTHS
12 MONTHS
*
PLAN
select
-- Select Plan --
GTPL UNLIMITED 200MBPS [ Rs. 5995 ]
GTPL UNLIMITED 200MBPS [ Rs. 9898 ]
GTPL UNLIMITED 100MBPS [ Rs. 4199 ]
GTPL UNLIMITED 100MBPS [ Rs. 5998 ]
GTPL UNLIMITED 100MBPS [ Rs. 6999 ]
GTPL UNLIMITED 80MBPS [ Rs. 4099 ]
GTPL UNLIMITED 80MBPS [ Rs. 5498 ]
GTPL UNLIMITED 60MBPS [ Rs. 4000 ]
GTPL UNLIMITED 60MBPS [ Rs. 4998 ]
Business Hierarchy
Basic Information
*
CUSTOMER TYPE
-- Select Customer Type --
INDIVIDUAL
ORGANISATION
*
CAF #
*
TITLE
Select Title
Mr
Mrs
Miss
*
FIRST NAME
*
LAST NAME
*
MOBILE #
Click on verify button and enter OTP to process
ALTER MOBILE #
*
E-MAIL
AADHAR #
Address Information
MULTISTOREY ( >= 4 FLOORS )
Yes
No
Installation Address
*
TALUKA/CITY
-- Select City --
AHMEDABAD
BARODA
RAJKOT
SURAT
DISTRICT
STATE
*
AREA
Select AREA
*
PINCODE #
*
FLAT NUMBER
*
SOCIETY NAME
FULL ADDRESS/AREA
*
LANDMARK
Billing Address
Same As Installation Address
*
TALUKA/CITY
DISTRICT
STATE
*
PINCODE #
*
FLAT/HOUSE NUMBER
*
BUILDING/SOCIETY NAME
*
LANDMARK
ADDRESS LINE
Document Detail
DOCUMENT TYPE
*
DOCUMENT SUBTYPE
*
DOCUMENT REFRENCE ID
*
UPLOAD DOCUMENT
*
ACTION
Select
* Proof of address & Proof of identity are mandatory
Upload Customer Photo
UPLOAD SIGNATURE
*
UPLOAD PHOTO
*
Customer Signature
I have seen all orignal documents and verified
Accept Terms
Accept the
Terms and conditions
Make Payment
AMOUNT
PAYMENT MODE
DEPOSIT BANK
Feedback
Mobile phone verification
×
Enter the code we just send on your mobile phone
Resend OTP
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