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EFAIZENT Network ( LA 0004838 - X )
No. 29. Lorong Bunga Bakawali 4,
Taman Penampang,
Batu 2 1/2. Jalan Penampang,
88200 Kota Kinabalu, Sabah.
Malaysia.
Phone : 088 - 456361
Fax : 088 - 456362
Mobile Phone : 019 - 8813858

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Application Form

This application assumes for :

Unless otherwise Specified

Self Installation Modem :

Yes

Your Neighbor Tel No. ( If Any ) :

For New Tel Lines application only

Full Name / Company Name * :

( As on your phone bill and NRIC or Passport )

NRIC No. / Company No. :

( Old IC Number is not Accepted )

Email * :

( Must be Valid Email )

Address :

For Streamyx : As on your Telekom Phone Bill

( As on your Telekom Phone Bill ) :

For New Tel Lines : Your Current Address

City :

Zip / Postcode :

State :

Phone No. :

( Where Streamyx is to be installed )

Mobile No. * :

( For contact purpose )

Preferred Username :

( Choice 1 )

( 3 or 8 characters ) :

( Choice 2 )

( Choice 3 )

Remarks :

Important :
Please Contact Us Via Phone or SMS if you do not Receive our Reply within 12 Hours. If you're address outside Kota Kinabalu, Sabah. Please scan your IC and send to us via email.....