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Personal Form

For subscription to MediaRing 1551 IDD service, please fill up the form and click on the SUBMIT button below.

Fields marked "*" are mandatory.


My Particulars

Name as in NRIC/Passport/FIN:
Dr. Mr. Miss Mrs. Mdm.
Name * :
Surname* :

Identification

Type*   Identification Number*
NRIC :
Passport/FIN :
Nationality* :
Residential Address* :
Postal Code* :
Residential Contact* :
Pager/Mobile* :
Fax :
Email* :

Payment*

Credit Card GIRO
Name on Credit Card :
Master Visa Amex    
Credit Card No. :
Expiry Date (mm/yy) :
 

Registration*

Please register the following telephone/mobile/fax number for MediaRing IDD international telephone services
: Tel Fax Mobile
: Tel Fax Mobile
: Tel Fax Mobile
: Tel Fax Mobile
: Tel Fax Mobile
Remarks :

Authorisation*

 
I have read and accepted MediaRing terms & conditions for info-communication services. For enquiries, please call 6324-1551 or email sales@mediaringidd.com
 


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