ISDN Dial-Up Connection Order Form

Customer Name:…………………………………………………………………….

Authorized person (establishments):…………………………………………………..

Username 

Acc.No

Tariff Plan

Connection Speed:

64kbs

Name: ..................................................................

Date: ...............................

Signature: .............................................................

Stamp: .............................

For Teleyemen use only

Deposit paid by:    Cash

Check

Receipt No:

Letter form place of work

Guardian Letter

Branch                      Salesman                     Date:    /     /                       Stamp