Yahoo! BB/BB Phone

Service Application Form for Personal Users
Please fill in the information below completely.
We will contact you by telephone or fax to get your payment information, and submit your application to Yahoo!
Please fill in all fields completely in English characters (romaji) before submitting.
Application Info
Telephone Number applying for:
Family Name:
Given Name:

Japanese Pronunciation:
(e.g. John Smith = Jo-n Su-mi-su in English characters (romaji) )
Sex:

Address:
(in English characters (romaji) ) 		line 1:
line 2:
line 3:
line 4:
Postal Code:
Date of Birth: YYYY MM DD
e-mail address:
Daytime contact Telephone number:
Payment Method:
We will contact you by telephone or fax to get your payment details.



Are you the owner of the phone line?
   - If not, please enter the name of the owner:
Will BB Phone be used at the address above?
   - If not, please fill in the address for BB Phone:
line 1:
line 2:
line 3:
line 4:
Application Options
Package applying for:



Would you like to enable Caller ID for calls to fixed lines?:
(Calls to cellular phones will not be enabled)

What type of phone billing details would you like?:




Would you like to rent or buy the modem?:


Additional Information
How would you like us to contact you?
   - If you chose fax, please enter your fax number:
Where did you hear about Planetworks:

Other:
  
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