GIGANET Internet Access Service Application

Dial-up IP Access Service


(last updated April,2000)

I hereby certify that I have read and understood the Dial-up User Agreement and apply for GIGANET Internet access service from Business Network Telecom (BNT).

Dial-up User Agreement

Date Applicant's Signature Guardian's Signature (if necessary)
User's Name:
Japanese (Katakana OK) English
Gender Birthdate E-mail address (if you have one)
Male | Female 19
Contact Information:
Company Name:
Address:
Telephone Fax
Method of Payment (Please circle choice): (GIGANET ANNUAL customers can use bank or post office transfer)
* Payment by Credit Card: (For GIGANET ANNUAL we can only accept Saison cards)
Type of Card (circle one): VISA | Master | JCB | UC | NICOS | AMEX | SAISON
Name on Card: Account Number: Expiration Date:
* Bank Transfer or Post Office Money Transfer (Be certain to include name on sender's account)
Name on Sender's Account:
* Automatic Account Withdrawl (Bank or Post Office Account): We will send you an application form later.
Desired Service (Please circle your choice): Access Type (Please circle your choice):
Monthly64 | ANNUAL 64 | ANNUAL 128 Analog | ISDN 64K | ISDN 128K
Would you like to sign up for GIGANET's "Access From Here" Service?
Yes No
Enter a Desired Username:
Please enter your choices for usernames. They must be in all small letters and between 3 and 8 characters. Use only letters or numbers, no punctuation. Your e-mail address will be your username followed by @giganet.net. Please be certain to enter three choices as your first or second choice may already be taken.
First Choice: Second Choice: Third Choice:
Operating System (OS) of your computer (Please circle one)
WINDOWS 95 WINDOWS 98 MACINTOSH
OS version: 		Other (Specify ________)
How did you hear about GIGANET?
Friend Magazine (Specify Title) Other
Would you like to receive information about KDDI Japan's (0070) discount long-distance service?
Yes No

Thank you for your application to GIGANET!

Please fax this form to 03-3548-1579

Read the User Agreement
Service Description