Application For Service & Products

Name of Primary Customer (Required)

Name of Joint/Customer (Optional)

i.e. Spouse, Partner, Co-applicant, etc.

Email (Optional If Available - or one may be assigned)

Phone Number of Contact Person (Mobile or Landline Required)

(i.e. +63.969.555.1212) (if multiple numbers seperate by commas)

Date of Birth Primary Customer (Required)

YYYY

Social Media URL Address's (Optional)

(Facebook, Messenger, Instagram, etc.) (seperate by commas)

Address Where Equipment Will Be Installed (Required)

Please select

Billing Address If Different From Above (Optional)

Explain Property Status Only If Applicant/s Are Not the Owner/s (Optional-owners name, contact info, etc.)

Preferred Date of Installation (Optional)

2025

Special Request / Additional Information (Optional)

(i.e. mesh setup, dish/equipment in specific location, etc.)

Monthly Rental Subscription Kit & Installation Plan#4990

₱4990.00

Quantity

Short Term Daily Rental Kit Plan#1499

₱1499.00

Quantity

*[Monthly Rent 2 Own Subscription Kit Plan#999](https://wifiph.com/shop-prices-%26-plans)0
*

Monthly Rent 2 Own Subscription Kit Plan#9990

₱9990.00

Quantity

Requires 32-month Fixed Contract

Previously Owned Kit Transfer Plan#79900

₱79900.00

Quantity

UPS 3000VA / 2700W Battery Backup Uninterruptible Power Supply

₱17990.00

Quantity

Purchase or Rental Options

Monthly Maintenance Plan#2990

₱2990.00

Quantity

Virtual Monthly Rental Subscription Kit Plan#4990%MI%V (Nationwide)

Virtual Monthly Rental Subscription Kit Plan#4990-V (Nationwide)

₱4990.00

Quantity

Other Value-Added Products/Services

₱0.00

Quantity

Signature

Sign With Device, Mouse, or Finger

Date

2025

Verification

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