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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

No
 
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

No
 
Does your PC have a LAN Card installed?

Yes

No
 
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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