ISP-V

MAHANAGAR TELEPHONE NIGAM LIMITED,DELHI
APPLICATION FORM FOR WEB HOSTING SERVICES
FOR HELPDESK USE
Commissioning Date .........................
Domain Name..................................
IPAddress.................... Signature.......
FOR OFFICE USE ONLY
Password Reference No.-------------
Customer Code--------------
Booking Date-------------- Signature--------






Note:Please read the instructions & broad terms and conditions before filling up the form.
1.PERSONAL/COMPANY DETAILS

A) Name
                                               


B)Address for
                                               


Correspondence
                                               


Pin
           


C) Contact Phone No.------------------              Fax No.-----------------------
(For informing account details)

2.SERVICE OPTED :(Please tick your choice)

Disk Space Web page hosting Web Server hosting Co-location
        5 MB         10 GB Data Transfer  
        10 MB            20 GB Data Transfer       
        50 MB                50 GB Data Transfer      
        100 MB             Unlimited       
        200 MB                           
        500 MB                           
        1GB                           

3.DOMAIN NAME PARTICULARS:
A)--------------------------------------(Give detail if already registered).
B)Domain Name to be registered (1)------------------(2) -------------------

4.TECHNICAL DETAILS:
A)Details of OS Opted             Unix                 Window NT         
B)Database required--------------------
C)Any other requirement --------------------

6.Additional IP Address required -------------------------

7.PAYMENT PARTICULARS:
DD Number ----------------- Date---------- Amount---------------
Bank Name ------------------------- Branch ------------------
I/We have carefully read the terms and conditions of the agreement and technical specifications of MTNL Internet access Services and agree to abide by the same.

Date:                                                                                                        Signature of the Applicant




RECEIPT

Recieved from Mr./Ms-------------------------------------------------------------------------
Rs.-------(In words,Rs.---------------------------------------------------------------------)
Vide Cash/DD No.-------------------------------------- Dated------------------------------
Drawn on ---------------------------------------------------------(Bank's Name & Branch)


Customer Code/Ref. no.-----------------------                                                                 Signature


Note:1. Please quote your Customer Code No./Ref.no. for all future communications.

| Annexure | General Instruction |