APPLICATION FORM FOR CABLE MODEM
Name/Company Name :
Contact Person :
Profession/Title :
Connection Address :
Connection Area :
Telephone :
Email :
Fax :
Billing Address :
Telephone :
Fax :
Type of Account :
Official
Personal
Student
Computer Type :
IBM/Compatible
Macintosh
iMac
Laptop
Access Speed :
Only for Individual User
None
48/16 kbps
Only for Corporate User
None
32/24 kbps
64/32 kbps
128/64 kbps
256/128 kbps
512/256 kbps
Our Current User :
Yes
No
Choose Your Option :
Option 1
Option 2
As the offer is on first come first basis, so you are coming to GCL office for payment of Cable Modem within
3 Days
7 Days
Minimum Configuration :
For IBM Compatible :
(i) Processor : Pentium I (ii) RAM : 32 MB (iii) CD-ROM
(iv) Ethernet Card (UTP) (v) TCP/IP for Windows 95/NT
For Macintosh/iMac :
(i) Mac OS 7.0 (ii) RAM : 32 MB (iii) CD-ROM
(iv) Ethernet Card (UTP) (v) TCP/IP for Windows 95/NT
