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Installation Date : Sales email :

Customer Details
Customer ID :
Customer Name :

Correspondence Address :

Phone Number :
Fax Number :
Contact Person :
Email Telp
Technical Contact :

Technical Details
Technical Configuration
Activation Link Date
Billing Activation Date
Packet of Service
Work Order Installation Upgrade Downgrade Mutation Termination
IP Address (for IP Public)
Note :

Device Details *)
Device Model Description Serial number Quantity

*) Device and its supporting facilities used for commencement of service remain in the ownership of Hotzone.
Note : All information must be fill. Please sign this form and fill up the date of installation.

Installer Customer

Cyber Building 3rd Floor, Kuningan Barat No.8, Jakarta 12710

Telephone: +6221.292.45.215 | Fax: +6221.5290.5145
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