<p>Order Form Biznet Data Center</p><p>Note: Please provide detailed information so we can provision the service faster. Please scan Sales Code & email the Order Form, or fax to +62-21-5700580.</p><p>Customer Information Company Name/Customer Name:</p><p>Address:</p><p>Contact Person: For technical inquiries or installation, please contact Contact Title: Technical Contact Person: Phone: Phone: Fax: Fax: Mobile: Mobile: Email: Email:</p><p>Billing Information Billing Address:</p><p>Billing Contact Person: Billing Contact Fax: Billing Contact Title: Billing Contact Email: Billing Contact Phone: ID No (KTP/Driver License): NPWP/Tax ID:</p><p>For payment with credit card, please fill the information Credit Card Type: Master Card/Visa Credit Card No: Credit Card Name: Credit Card Exp Date:</p><p>Service Information Data Center Location: [ ] MidPlaza [ ] Biznet Technovillage [ ] Bali* Service Type: [ ] Suite/Secure Cage. Dimension: [Length _____ m x Width _____ m] = Area _____ (*) Services that Bali m2 Data Center provided [ ] Closed Rack Space [ ] 14U [ ] 21U [ ] 42U*</p><p>[ ] Bundle Closed Rack Space 42U + Power 10A – 220V* </p><p>[ ] Bundle Closed Rack Space 42U + Power 20A – 220V*</p><p>[ ] Bundle Closed Rack Space 42U + Power 32A – 220V*</p><p>[ ] Shared Rack Space ____U</p><p>PT Biznet Data Center - Biznet Data Center Order Form - Confidential Information 6/8/2018 [ ] Secure Cage Space _____ m2 (Midplaza)</p><p>[ ] Secure Suite Space _____ m2 (Technovillage)</p><p>[ ] Open Space _____ m2</p><p>[ ] Rack 42U Rental _____ Unit</p><p>[ ] Additional Power: ____ Watts ______A*</p><p>[ ] Cross Connect Cable [ ] UTP [ } Fiber Optic</p><p>[ ] Others: ______Monthly Fee : One Time Setup Fee:</p><p>Other Service Information</p><p>Apakah perusahaan Anda Postpaid Biznet Dedicated Internet & Biznet DataComm saat ini menggunakan Prepaid Biznet Metronet layanan Biznet? / Is your company currently using Biznet Cable TV Office Biznet services? Lainnya, sebutkan:</p><p>Service Capacity : ID Pelanggan Biznet / Biznet UserID :</p><p>Technical Installation Information Contact Person: Additional Installation Information Name: Phone: Mobile: Email:</p><p>Authorization I/We hereby confirm that the information above is true Signature & Company Stamp Print Name: and agree to be bound by Biznet Data Center Terms and Conditions and we are the authorized to signed the services Order Form. Biznet has right to refuse this application without any explanation. Biznet Data Center Terms and Conditions can change anytime without Date: further notice. For credit card payment, I/We hereby authorize Biznet to charge the credit card for service charge I/We chose</p><p>PT Biznet Data Center - Biznet Data Center Order Form - Confidential Information 6/8/2018 Internal Use Account Executive Supervisor Branch Manager Provision Engineer</p><p>Date Date Date Date</p><p>Please attach the following copies [ ] Tax ID/NPWP for corporate customer, KTP/Passport/ID Card for personal customer [ ] Credit Card (Front & Back) for payment with credit card only</p><p>PT Biznet Data Center - Biznet Data Center Order Form - Confidential Information 6/8/2018 </p>