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 ]
Required Plan
Business Hierarchy
Basic Information
*
CUSTOMER TYPE
-- Select Customer Type --
INDIVIDUAL
ORGANISATION
Required Customer Type
*
*
CAF #
*
TITLE
Select Title
Mr
Mrs
Miss
Required Title
*
FIRST NAME
Required First Name
Invalid First Name
*
LAST NAME
Required Last Name
Invalid Last Name
*
MOBILE #
Required Mobile No
Click on verify button and enter OTP to process
ALTER MOBILE #
*
E-MAIL
Invalid email address
Required Email
AADHAR #
Invalid Aadhar Number
Address Information
MULTISTOREY ( >= 4 FLOORS )
Yes
No
Installation Address
*
TALUKA/CITY
-- Select City --
AHMEDABAD
BARODA
RAJKOT
SURAT
Required City
DISTRICT
STATE
*
AREA
Select AREA
Required Area
*
PINCODE #
Required PinCode
*
FLAT NUMBER
Required Flat/House Number
*
SOCIETY NAME
Required Building/Society Name
FULL ADDRESS/AREA
*
LANDMARK
Required Landmark
Required to Validate
Billing Address
Same As Installation Address
*
TALUKA/CITY
Required City
DISTRICT
STATE
*
PINCODE #
Required PinCode
*
FLAT/HOUSE NUMBER
Required Flat/House Number
*
BUILDING/SOCIETY NAME
Required Building/Society Name
*
LANDMARK
Required Landmark
ADDRESS LINE
Document Detail
DOCUMENT TYPE
*
DOCUMENT SUBTYPE
*
DOCUMENT REFRENCE ID
*
UPLOAD DOCUMENT
*
ACTION
Document type Required
Select
Document Sub type Required
Enter proper format
Only JPEG JPG PNG & PDF files are allowed
* Proof of address & Proof of identity are mandatory
Upload Customer Photo
UPLOAD SIGNATURE
*
UPLOAD PHOTO
*
Required Photo to Upload
Customer Signature
I have seen all orignal documents and verified
Please Check Terms and conditions
Accept Terms
Accept the
Terms and conditions
Please Check Terms and conditions
Make Payment
AMOUNT
PAYMENT MODE
DEPOSIT BANK
Feedback
Mobile phone verification
×
Enter the code we just send on your mobile phone
Required OTP
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