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New Dial-Up Registration Form

The following form is provided for registering new user at Bozz.com. Please complete the form and click Register button to continue the process. We will then immediately contact you to complete the registration within 1 (one) work day. Click here to review the price list.

Name *
Company / Organization
Position
Home Address *
Work Address
Billing Address
Phone Number	(home) * (office) * (handphone) *
Fax
E-mail	(optional)
ID / Passport Number *
Birth Date *	/ / (dd/mm/yyyy)

Payment Method
Credit Card Number
	Expiry Date: / 20

User ID #1
User ID #2	(as alternative user ID if the first is not available)
Password
Confirm Password
For User ID and password, please use alphabethical characters 'a' - 'z', and numeric '0' - '9'. Min. 3 chars for User ID, and min 5 chars for the password. Max. 8 characters. First character should be an alphabeth.


Rewards Program (membership rewards)
Reference User ID / Promotion Code

TERMS AND REGULATIONS

Payments can be made via transfer, ATM BCA or cash to Bozz.com office.
If paying via ATM BCA, please confirm the receipt's sequence number (No. Urut) to Customer Service (021-3903939).
For other payment methods, please send or fax the proof of payment or fotocopy of your credit card to:
PT Bitnet Komunikasindo,
Jl. R.P. Soeroso No. 37, Jakarta 10350
Fax : (62-21) 3903938
Bozz.com will activate the User ID and Password after the first payment is made and confirmed.
For administration purpose, please send your valid copy of ID card / Passport to the address above.
Customer may not sell the the internet connection to any third party.
Customer is responsible to keep his/her User ID and Password from disclosure and usage by any third party.
Due date of payment for internet connection is 20th of each month. In the case we haven't received payment due 5 days after the due date, the internet connection will be blocked automatically.
Payment via bank transfer can be made to the following accounts:

PT Bitnet Komunikasindo BNI Cabang Gunung Sahari a/c 10543875	PT Bitnet Komunikasindo BCA Cabang Gondangdia a/c 455-3009017
PT Bitnet Komunikasindo BCA Cabang Taman Sari a/c 285-3000361

AGREEMENT

I / we agree to be bound by the Terms and Conditions set above by PT. Bitnet Komunikasindo.
This Terms and Conditions are subject to change if necessary, notice will be given to me / us prior to the changes.
I / we confirm that the information herein given is true and correct.

CONFIRMATION

Please enter the confirmation code as appears above.

Please click on the Register button below to continue the application.