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              Today is September 8, 2008
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Personal Information
         *Last Name         *First Name        *Middle Name
 
From time to time, we will ask you your birth date to ensure that only you can access your account. Please provide your birth date.
Day Month Year
 
Please tell us where we can reach you to provide updates.
Mobile Number Current E-mail Address
Area Code Landline Number Area Code Office Number
 
Please tell us where you would like us to install your SMART WIFI Service.
Unit# / Floor Building Name Street No. Street Name
Subdivision / Village Barangay
 
Province City Zip Code
 
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If not, please tell us where you’d like us to send your bill.
Unit# / Floor Building Name Street No. Street Name
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Account Information
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Account Information
Please indicate your preferred email address and 2 alternatives
1.  @ pldtdsl.net
2.  @ pldtdsl.net
3.  @ pldtdsl.net
 
Do you have a personal computer (PC) at home?
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Does your PC have a LAN Card installed?
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I have read and accepted the Terms and Conditions written on this form.


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