UltraBand Registration Form Please key in the correct information. 1Select Building2Valid Information3Payment Do we cover your Residence?*Select your residenceM-City Modern DuplexKojaya CondominumD'suria CondominiumPermai Puteri ApartmentPermai Seri ApartmentPermai Court 1 ApartmentPermai Court 2 ApartmentPlan*30Mbps - RM75 Monthly100Mbps - RM150 Monthly200Mbps - RM200 Monthly300Mbps - RM300 MonthlyBlock Level* Unit* Name* First Last Email* Phone*Passport/IC Front*Max. file size: 10 MB.IC BackMax. file size: 10 MB.Username* Password* Consent* I agree to the privacy policy.- The contract is for 24 months. - The deposit is not refundable within 2 years. - The deposit will refund back within 90 days after collected back the devices. - The customer must provide 30 days' notice prior to termination of the contract. Total RM 0.00 Choose Your Payment Method* Debet Card Credit Card Credit Card* American ExpressDiscoverMasterCardVisaJCBMaestroSupported Credit Cards: American Express, Discover, MasterCard, Visa, JCB, Maestro Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.
