APPLICATION FOR: Company          Individual

Applicant Name

Mailing Address

Tel No.

Fax No.

Contact Person

E-mail (must be provided in order to receive the user id and password)

     Total DID Subscribed 1 2 3 4 5 6 7 8 9 10

Full Package Subscription
     1 DID (RM 649) 2 DID (RM 1298) 3 DID (RM 1947) 4 DID (RM 2596) 2 DID in same adapter (RM 649 + RM 150)
VoiZIP DID Subscription
     1 DID (RM 250) 2 DID (RM 500) 3 DID (RM 750) 4 DID (RM 1000)

     Cash Cheque Maybank ATM Fund Transfer Maybank Phone Banking Others

     Please make the payment to Ivory Network Sdn Bhd and fax in the bank slip to (6)03-9200 1279.
     For payment with cheque, kindly e-mail us the name of bank issuer and cheque number.
     (Bumiputra-Commerce Bank A/C No: 1422-001179-1058)

I hereby declare that I wish to subscribe for VoiZIP service and that the information provided are complete, valid and
     true. I have read and agree to be bound by the Terms & Conditions. Activation of VoiZIP service will only be proceed
     upon receivable of full payment.