Please fill up the form below or download the pdf format.
1.  Administrative Information

Full Name

Birthday

Gender
Male Female

Civil Status
Citizenship

Home Address 1

Home Address 2

Office Address 1

Office Address 2

Email (your monthly bill will be emailed here)

Web address

http://

Home Phone

Office Phone

Mobile

Fax

Username*

Password*
2.  Account Information
     
WAVE Internet
  • Unlimited hours/month
  • No contracts - accounts are billed monthly
  • 56K connection
  • Same day activation
  • 6x 50MB emails@pinoysurfer.com
  • 20MB web space at http://member.pinoysurfer.com
  • Php 440.00/mo
  • Php 500.00 One-time Set-up fee
  • Dial-up number: 448-5323

Notes:
  • *Please use a combination of small letters and numbers only.  Use a minimum of 3 characters and maximum of 12 characters.
  • **By signing and using the service, you signify acceptance of the Acceptable Usage Policy (AUP) governing the use of the service as indicated in the attached AUP.
  • Please fax this form to (632) 411-5971. Account will be activated within the hour after payment has been acknowledged. 
  • Please call 4107226 for payment details.
  • To expedite your order, fax us your validated check or deposit slip with your account name.
  • Monthly recurring bill will be emailed to the address indicated above. Accounts must be paid in advance before the next cycle starts. Automatic suspension shall be applied until paid.
  • Price Inclusive of VAT
3.  Where did you hear about us?

Internet
Broadcast
Referral
Print
Sales Representative
Others 
   
4.  Agreement

I confirm that the above information is true and correct. I agree to accept and be bound by the Acceptable Usage Policy which accompanies my account.
 
Before submitting this form, please make sure that all required fields are complete.  By pressing the Submit Button, you are placing an order and agree to pay for the services ordered based on the current pricing plans.  To avoid submitting multiple orders, please press the Submit Button only once.

We will process your account once payment has been received. To expedite your order, fax us your validated check or deposit slip with your account name and your account will be activated within a day.