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HOME > Application Form

Application Form

Provide all the applicable information ask below, if not, your application will not be processed.

Personal Information


* Last Name	* First Name	* Middle Name

From time to time, we will ask you your birth date to ensure that only you can access your account. Please provide your birth date.


* Month	* Year

Please tell us where we can reach you to provide updates.


Mobile No.	Current E-mail Address


Area Code	Landline No,

Area Code	Office No.

Mother's Maiden Name (for verification purposes)

Please tell us where you would like us to install your PLDT myDSL Service.

Unit/Floor #	Building Name	Street No.	Street Name


Subdivision/Village	Barangay


Province	City	Zip Code

Would you like us to send your bill to the address you have supplied above?

Yes

If not, please tell us where you’d like us to send your bill.

Unit/Floor #	Building Name	Street No.	Street Name


Subdivision/Village	Barangay


Province	City	Zip Code

In case the one applying is not the subscriber, please provide the following information:


Subscriber's Name	Relation to Subscriber

Account Information

Preferred DSL Phone No.


Area Code	Phone No,

Packages to Avail

Please indicate your preferred email address and 2 alternatives

1.		@pldtdsl.net
2.		@pldtdsl.net
3.		@pldtdsl.net

Do you have a personal computer (PC) at home?

Yes

Does your PC have a LAN Card installed?

Yes

I certify that all the information I have provided is true and correct.
I have read and accepted the Terms and Conditions written on this form.

I agree to the terms and conditions.

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