QMAX Singapore Pte Ltd

Customer Support Hotline	:	6796-0350
9:00am to 6:00pm (Mon-Fri), except PH
24-hour Technical Support Hotline	:	6796-0360


QMAX - PREMIUM ONLINE SUBSCRIPTION FORM

* Please ensure that all fields are to be completed in full to avoid delay in the process of your application. Our sales staff will contact you within 24 hours to confirm the creation of your account.

PRODUCT SUBSCRIPTION
Subscription Type :	No Contract Subscription One Year Contract Two Years Contract Includes FREE Lease of Modem 3 POP Email Account 300Mb Mail Storage (100mb each) One-Time Charge(OTC applies) No Delivery Charges Plug & Play Simplicity Free 2 Days Trial
Product Type :	OTC :
Product Price: 12 Months Plan : 256k ($11.90, 2 mths FREE), 512k ($21.90, 2 mths FREE), 1000k ($33.17), 1500k ($37.45) 24 Months Plan: 256k ($11.90, 4 mths FREE),512k ($21.90, 4 mths FREE),1000k ($33.17, Creative Zen (4GB) FREE), 1500k ($37.45, Creative Zen (4GB) FREE) All prices are inclusive of 7% GST
PERSONAL APPLICATIONS
Name (as stated in NRIC / Passport):
NRIC / Passport Number / FIN:
Date of Birth :
Mobile No. :
Home Tel :
Installation / Billing Address :
Postal Code :	Country
Current Email :
EMAIL ACCOUNT (FREE), EACH 100MB SIZE
1st Email Account :	@qmax.com.sg
2nd Email Account :	@qmax.com.sg
3rd Email Account :	@qmax.com.sg
Preferred Method of Payment :
Name of Credit Card Holder :
Credit Card Number :
Remarks :
NOTE: Applicants who are under 21 years of age are required to get Parental/Guardian's consent and signature on application-cum-service Agreement and submit a photocopy of parent/guardian NRIC / Passport.

APPLICANT'S SIGNATURE AND UNDERTAKING:
I hereby confirm that the above given by me is true and correct and agree to accept and be bounded by such terms & conditions, which accompany the account. I acknowledge that the use of my QMax Account is subjected to the minimum subscription period as specified above and I will be liable for surcharge if I prematurely terminate the subscription as stated in the Terms & Conditions which I acknowledge that I have been given a copy of. I/We further agree that the terms and conditions of this agreement are subjected to ammendments by QMax Singapore from time to time, as QMax deem appropriate.

2 days FREE Trial: If in any case that I am unhappy with the service rendered duly from the trial start date as stated above, I have the right to terminate this service completely without monetary obligations to QMax within 2 days of the trial date. In such circumstance, I am responsible and must returned the modem to the address stated within 2 days, otherwise, I can be billed for a full 24 months subscription.



Promotional is subjected to terms and conditions as specified by QMax Singapore Pte Ltd, offer is good while stock lasts on a first come first served basis.

QMax Singapore Pte Ltd, 31 International Business Park, #05-05, Creative Resource, Singapore 609921. Tel: +65 67960313. Fax: 6796 0343. Website: www.qmax.com.sg. Email: sales@qmax.com.sg