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Application Form

Please specify Membership type :

Product Type :	*
KSC Premioum Account	1 month 599.00 Baht	6 months 3,234.60 Baht	12 months 6,109.80 Baht
KSC Economy Account	1 month 349.00 Baht	6 months 1,884.60 Baht	12 months 3,559.80 Baht
KSC Unlimited Usage	Monthly Fee 1,499 Baht
Business Service	Business I 1,950 Baht	Business II 3,500 Baht	Business III 6,000 Baht
	Business IV 7,000 Baht
KSC V3 Plus	25 Hrs 279 Baht	43 Hrs 449 Baht
Sanook Card	12 Hrs 99 Baht	25 Hrs 199 Baht	50 Hrs 259 Baht
ISDN Standalone	50 Hrs 1,300 baht	100 Hrs 2,450 Baht	250 Hrs 5,700 Baht
	500 Hrs 10,500 Baht	1,000 Hrs 20,000 Baht
WIDE Broadband ADSL	256/128 Kbps 1,000 Baht	512/256K Kbps2,000 Baht	1024/512K Kbps 4,000 Baht
Corporate ADSL (Monthly Fee)	128 Kbps 8,900 Baht	256 Kbps 15,900 Baht	512 Kbps 26,900 Baht

First Name Mr./ Mrs. / Ms. :	*
Surname :	*
Date of Birth :
Passport No :	*

Billing Address :	Individual	Corporate

Corporate Name :
House No. :
Bldg. :
Room No. :
Address :	*
Province :	*
Zip Code :	*
Tel :	*
Fax :	*
E-mail :	*
* The real account owner is the one whose name and address appeared on a receipt*

Documents Required :

Individual : Photocopy of ID Card or Passport and a proof of payment.
Corporate : Photocopy of Juristic Person, photocopy of VAT Registration Certificate and a proof of payment.

Login Name :

Please use 4-8 character letters and/or digit except all symbols. KSC reserves the right to change your Login Name in case of duplication.

First Choice :	*
Second Choice :	*
Password :	*
Confirm Password :	*
Applicant's Operating System Please check one	CD-Rom (Win95/98/NT/2000/XP)	Macitosh

I, the applicant, have read and hereby confirmed the accuracy of all information in this application form and will agree to read and understand the Membership Conditions. I agree to abide fully by rules and regulations of Internet KSC and the Communications Authority of Thailand starting from the effective date of membership and have, therefore, affixed my signature below.

Date :

Remarks : - KSC will open Membership Account for the applicant within 7 days after KSC received the completed application form and other documents required.

• In all cases, the application fee and membership fee are non-refundable unless KSC rejects this application.
• Membership shall be renewed automatically unless subscriber gives KSC a written notice to terminate the membership.

Methods of payment

Cash : Pay directly at KSC Phuket office, Monday - Friday 09.00 am. - 05.00 pm.
Saturday 09.00 am.- 05.00 pm.

Fund Transfer (Cash or Cheque) to Saving Account
- Siam Commercail Bank A/C Number 537-2-54700-5 A/C Name Express Data Co.,Ltd.
- Thai Farmaer Bank Phuket BranchA/C Number 102-2-55855-9. A/C Name Internet KSC Phuket

Cheque made an "A/c payee only" cheque payable to "Internet KSC Phuket Branch"

Payment Online http://www.phuket.ksc.co.th/payment_online.php

* Remarks - If pay by Fund Transfer, please send the pay-in slip together with
the application form and document(s) require to us by Mail (support@phuket.ksc.co.th)
or Fax: (6676 215933).
- If pay by cheque, please mail cheque together with the application form and document(s) require to us at Internet KSC Phuket, 73/2 Rasada Road, A.Muang, Phuket, Thailand 83000

Please specify Validate Code
*

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Internet KSC Phuket Branch 18/72 Moo 5, Vichitsongkram Road, T.Vichit, A.Muang, Phuket 83000 Tel: (66) 076-304090, Fax (66) 076-304095 email: support@phuket.ksc.co.th Copyright 2000. Expressdata Co.,Ltd. All rights reserved Design by Expressdata l Search Phuket