Termination Form Prepaid

Termination Form

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Customer Information
Requestor Information
Type
N/A
Name
N/A

Required
Salutation Required Fullname
Email *
N/A
Mobile *
N/A

E.g: +62 812 5578xxxx
Mobile 2
N/A

E.g: +62 812 5578xxxx

Service Information
Biznet Service *
N/A

Biznet Home
Biznet Metronet
Company Name *
N/A
Customer Name
N/A

Salutation Full Name
Customer BP ID *
N/A

E.g: CA2007XXXX/1100000XXXXXX
Customer Number *
N/A

E.g: 3100000XXXXXX/SI2002XXXX-XXXX

Terminate Information
Termination Submission Date
N/A

dd-MMM-yyyy HH:MM AM/PM
Service Termination Request Date *
N/A

dd-MMM-yyyy
Service Termination Request Date *
N/A

dd-MMM-yyyy
Device Dismantle Request Date *
N/A

dd-MMM-yyyy HH:MM AM/PM
Terminate Reason Segment *
N/A

Biznet
Competitor
Internal Customer Reason
Terminate Reason Segment *
N/A

Biznet
Competitor
Internal Customer Reason
Terminate Reason Detail *
N/A

After Sales - Hard to Contact
After Sales - Staff Not Help
Hardware - Bad Router/Modem
Network - Internet Issue
Network - Static IP
Payment - Payment Difficulties
Price - Additional Fee Occurred
Price - More Expensive
Product - Unsatisfied Service
Schedule - Installation Issue
Schedule - Takes Too Long to Solve Issue
Other
Terminate Reason Detail *
N/A

After Sales - Hard to Contact
After Sales - Staff Not Help
Hardware - Bad Router/Modem
Network - Internet Issue
Network - Static IP
Others - 3rd Party Issue
Payment - Payment Difficulties
Price - Additional Fee Occurred
Price - More Expensive
Product - Unsatisfied Service
Schedule - Installation Issue
Schedule - Takes Too Long to Solve Issue
Other
Terminate Reason Detail *
N/A

Price - Better Price
Product - Better Product
Service - Better Facility
Service - Better Service
Other
Terminate Reason Detail *
N/A

Price - Better Price
Product - Better Product
Service - Better Facility
Service - Better Service
Other
Terminate Reason Detail *
N/A

Account - Move Abroad
Account - Change Product
Coverage - Uncovered Relocation
Other
Terminate Reason Detail *
N/A

Account - Move Abroad
Account - Change Product
Billing - Change Bill Cycle
Billing - Invoice Combine
Billing - Invoice Split
Business - Business Closed
Business - Budget Efficiency
Business - Management Decision
Coverage - Uncovered Relocation
Other
Help us to improve *
N/A
Help us to improve *
N/A
Notes
N/A
Signature *
N/A

E-Signature Field
Clear

• We hereby confirm that the information above is true and agree to be bound by Biznet’s Terms and Conditions which written and signed on Order Form.
Verification Code *
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