Hirani Telecommunication

HIRANI TELECOMMINICATION LTD: APPLICATION FORM

Client Code(Subscriber code): Receipt No:
First Name: * Last Name: *
 
Tel (Home): Tel (Office):
P.O.Box Address: Mobile Number:
Road/Street: Area:
Landmark:
Court/Building Name: Block/House No:
Email: *
Please retype the Email for verification:
City: Date Of Connection:
 PLEASE TICK ON THE SERVICES REQUIRED:
 Cable TV Terrrestial Internet
Notes:
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