City Broadband Application FormPlease enable JavaScript in your browser to complete this form.Select Internet Package: *ResidentialBusinessHome Package: *City Broadband Home 300Mbps (Xtra Vaganza Rewards - Triple The Speed) (24 Months Contract) @ RM99City Broadband Home 1Gbps Xtra Vaganza Rewards - Double The Speed) (24 Months Contract) @ RM139City Broadband Home 1Gbps (24 Months Contract) @ RM199Business Package: *City Broadband 50Mbps (24 Months Contract) @ RM99City Broadband 100Mbps (24 Months Contract) @ RM129City Broadband 300Mbps (24 Months Contract) @ RM129City Broadband 500Mbps (24 Months Contract) @ RM189City Broadband 1Gbps (24 Months Contract) @ RM259Voice Package: *Without Voice Add-onAddon RM20 - 1 Voice Line + 1 Dect PhoneFull Name: *Company Name: *SSM Business Registration No: *NRIC / Passport No: *Mobile Number: *Email: *Installation Address *Postcode: *State: *SelangorSelangorPulau PinangPerakMelakaKedahPreferred Installation Date: *Upload Your IC (Front )/ Passport: Click or drag a file to this area to upload. Upload Your IC (Back)/ Visa (Foreigner): Click or drag a file to this area to upload. Upload Director's IC Click or drag files to this area to upload. You can upload up to 2 files. Company SSM Document Click or drag files to this area to upload. You can upload up to 3 files. For Trading / Enterprise: Form D, Form A, Form BFor Sendirian Berhad /Berhad: Form 9, Form24, Form 49 Message (if any): Submit
