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    Adi Prasetyo6935 Form 2024-09-27 5501024181 1000025468

    Uploaded by

    rivofirmansyah033

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Adi Prasetyo6935 Form 2024-09-27 5501024181 1000025468

    Uploaded by

    rivofirmansyah033
    1 views1 page

    Original Title

    ADI_PRASETYO6935_FORM_2024-09-27_5501024181_1000025468

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    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    1 views1 page

    Adi Prasetyo6935 Form 2024-09-27 5501024181 1000025468

    Uploaded by

    rivofirmansyah033

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Biznet Networks - Termination Form

    Note: Please provide detailed information so we can provision the service faster. Please scan & email the service change form, or
    fax to +62-21-5700580.

    Customer Information
    Customer Name / Company Name (NPWP/Tax Name):
    Customer ID: 5501024181 Customer Number: 1000025468
    Termination Requestor
    First Name: Last Name:
    ADI PRASETYO
    Mobile: Home:
    +628999174233 +62
    Email:
    [email protected]

    Service Information
    Service Name:
    BIZNET HOME
    Service Termination Date:
    27-Sep-2024
    Termination Reason:
    Biznet - Payment - Payment Difficulties

    Termination Information
    Technical Contact Person
    First Name: Last Name:
    BUDI RAHMADI
    Mobile Number: Home Number: Email:
    +6282183223315 +62 BUDI_RAHMADI@BIZNETNETWORKS
    .COM
    Biznet Hardware: Hardware Dismantle Date:
    Write in details for return Uninstall and return date
    BUY

    Authorization
    Signature & Company Stamp, Print Name:
    This service change form will only be valid if terms and
    conditions is attached.

    Note:

    We hereby confirm that the information above is true


    and agree to be bound by Biznet’s Terms and
    Conditions which written on signed the Order Form.
    Biznet has the right to refuse this application without
    any explanation.
    Biznet’s Terms and Conditions may change at any time
    without prior notice.
    For credit card payment, we hereby authorize Biznet to Date:
    charge the credit card for service type we chose. 27-Sep-2024

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