SUBSCRIBER NAME
*
ACCOUNT MANAGER
*
Please Select
ABRAHAM DE PERALTA
ALAN SMYTH
ALEAH JIMENEZ
ANGELICA HASHIM
BERNICE JOAN ROSARIO
CATHY CUBILE
CECILLE GARCIA
Dominico Ramon Lucindo
EMMANUEL LOPEZ
ERIC DESEMBRANA
FRANCIS MIGUEL
FRANCIS TUANO
GARRY GOYALA
JANET GONZALEZ
JANETTE APIGO
Jessie Herrera
Jofrey Marfil
Joann Mendoza
Jonathan B. Arenas
JULIE LUTAO
JULIUS DAOANG
KAREN DE GUZMAN
MARIE ANNA SAMPAGA
MARIVIC SALONGA
MARK TORIO
MARLON PARENO
MELL ROSE CABIGAO
MICHAEL LIZARDO
MJ MASACUPAN
NEIL SOLAMO
NELSON MOYANO
NIÑA DUGAY
ODETTE ADRIANO
Olive Ausan
PAUL LUCAS
Perfecto N. Ong Jr.
ROMA RAZALAN
QUEENIE CHAN LUGAY
SHERYL ANN ICASIANO
SHERYL VILLANUEVA
REGIONAL REQUIREMENTS
CONSUMER REQUIREMENTS
ACCOUNT MANAGER E-MAIL
*
SALES GROUP
*
Please Select
BPO/CONGLOMERATE
MANILA NORTH
MANILA SOUTH
GOVERNMENT
REGIONAL
TELCO/RESELLER
ASSIGNED PRESALES
*
Please Select
KRISTINA JANE MORILLO
MJ PASCUAL
JR BENITEZ
GLY APOLONIO
CJ SIMON
JENNIFER MALONG
WILLIAM VICERA
SERVICE REQUEST TYPE
*
Please Select
New Installation
Upgrade
Transfer
Change Package
SERVICE TYPE
*
Please Select
Coloc
Dark Fiber
Dedicated Internet
IPLC
Metro Enterprise
Others
SME
IBIZ
Transport
Transport via SDH
VSAT
BANDWIDTH
*
INTERFACE
*
Please Select
FE
GE
10 GE
40 GE
100 GE
INTERFACE MEDIUM
*
Please Select
OPTICAL
ELECTRICAL
SITE A ADDRESS
BUILDING NAME (SITE A)
BUILDING (SITE A)
ADDRESS 1 (SITE A)
*
FLR / BLK / LOT / NO / STREET NAME (SITE A)
ADDRESS 2 (SITE A)
SUDB. / VILL. / CMPD (SITE A)
BARANGAY (SITE A)
BARANGAY (SITE A)
CITY / TOWN (SITE A)
*
Please Select
Caloocan
Las Pinas
Makati
Malabon
Mandaluyong
Manila
Marikina
Muntinlupa
Navotas
Paranaque
Pasay
Pasig
Pateros
Quezon City
San Juan
Taguig
Valenzuela
Butuan
Bulacan
Baliuag
Bayugan
Cabadbaran
Legazpi
Ligao
Laguna
Tabaco
Isabela
Lamitan
Balanga
Batangas City
Bicol
Lipa
Tanauan
Baguio
Tagbilaran
Malaybalay
Valencia
Malolos
Meycauayan
Cainta
Rizal Province
San Jose del Monte
Tuguegarao
Iriga
Naga
Roxas
Bacoor
Cavite City
Dasmarinas
Imus
Tagaytay
Trece Martires
Bogo
Carcar
Cebu City
Danao
Lapu-Lapu
Mandaue
Naga
Talisay
Toledo
Kidapawan
Panabo
Samal
Tagum
Davao City
Digos
Mati
Borongan
Batac
Laoag
Candon
Vigan
Iloilo City
Passi
Cauayan
Ilagan
Santiago
Tabuk
San Fernando
Binan
Cabuyao
Calamba
San Pablo
Santa Rosa
San Pedro
Iligan
Marawi
Baybay
Ormoc
Tacloban
Cotabato City
Masbate City
Oroquieta
Ozamiz
Tangub
Cagayan de Oro
El Salvador
Gingoog
Bacolod
Bago
Cadiz
Escalante
Himamaylan
Kabankalan
La Carlota
Sagay
San Carlos
Silay
Sipalay
Talisay
Victorias
Bais
Bayawan
Canlaon
Dumaguete
Guihulngan
Tanjay
Cabanatuan
Gapan
Munoz
Palayan
San Jose
Calapan
Puerto Princesa
Angeles
Mabalacat
San Fernando
Alaminos
Dagupan
San Carlos
Urdaneta
Lucena
Tayabas
Antipolo
Calbayog
Catbalogan
Sorsogon City
Subic
General Santos
Koronadal
Maasin
Tacurong
Surigao City
Bislig
Tandag
Tarlac City
Olongapo
Dapitan
Dipolog
Pagadian
Zamboanga City
Zambales
Others
CITY / TOWN (SITE A)
COUNTRY (SITE A)
*
Please Select
Afghanistan
Africa
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua & Barbuda
Argentina
Armenia
Aruba
Asia
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, St.Eustat, Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean T.
British Virgin Islands
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Caribbean, the
Cayman Islands
Central African Republic
Central America
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Dem. Rep. of the
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor-Leste)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Europe
European Union
Falkland Is. (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Terr.
Gabon
Gambia, the
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey and Alderney
Guiana, French
Guinea
Guinea-Bissau
Guinea, Equatorial
Guyana
Haiti
Heard & McDonald Is.
Holy See (Vatican)
Honduras
Hong Kong, (China)
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Israel
Italy
Ivory Coast (Cote d'Ivoire)
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea Dem. People's Rep.
Korea, (South) Republic of
Kosovo
Kuwait
Kyrgyzstan
Lao People's Dem. Rep.
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao, (China)
Macedonia, TFYR
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Man, Isle of
Marshall Islands
Martinique (FR)
Mauritania
Mauritius
Mayotte (FR)
Mexico
Micronesia, Fed. States of
Middle East
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar (ex-Burma)
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North America
Northern Mariana Islands
Norway
Oceania
Oman
Pakistan
Palau
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Portugal
Puerto Rico
Qatar
Reunion (FR)
Romania
Russia (Russian Fed.)
Rwanda
Sahara, Western
Saint Barthelemy (FR)
Saint Helena (UK)
Saint Kitts and Nevis
Saint Lucia
Saint Martin (FR)
S Pierre & Miquelon(FR)
S Vincent & Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South America
S.George & S.Sandwich
South Sudan
Spain
Sri Lanka (ex-Ceilan)
Sudan
Suriname
Svalbard & Jan Mayen Is.
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Rep. of
Thailand
Timor-Leste (East Timor)
Togo
Tokelau
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Is.
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
US Minor Outlying Isl.
Uruguay
Uzbekistan
Vanuatu
Vatican (Holy See)
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
COUNTRY (SITE A)
CONTACT PERSON (SITE A)
*
CONTACT PERSON (SITE A)
CONTACT NUMBER (SITE A)
*
CONTACT NUMBER (SITE A)
SUBS EMAIL (SITE A)
SUBS EMAIL (SITE A)
SITE A GEO LOCATOR
SITE B ADDRESS
BUILDING NAME (SITE B)
BUILDING (SITE B)
ADDRESS 1 (SITE B)
FLR / BLK / LOT / NO / STREET NAME (SITE B)
ADDRESS 2 (SITE B)
SUDB. / VILL. / CMPD (SITE B)
BARANGAY (SITE B)
BARANGAY (SITE B)
CITY / TOWN (SITE B)
Please Select
Caloocan
Las Pinas
Makati
Malabon
Mandaluyong
Manila
Marikina
Muntinlupa
Navotas
Paranaque
Pasay
Pasig
Pateros
Quezon City
San Juan
Taguig
Valenzuela
Butuan
Bulacan
Baliuag
Bicol
Clark
Cainta
Subic
Cabadbaran
Bayugan
Legazpi
Ligao
Tabaco
Isabela
Lamitan
Balanga
Batangas City
Lipa
Tanauan
Baguio
Tagbilaran
Malaybalay
Valencia
Malolos
Meycauayan
Rizal Province
San Jose del Monte
Tuguegarao
Iriga
Naga
Roxas
Bacoor
Cavite City
Dasmarinas
Imus
Tagaytay
Trece Martires
Bogo
Carcar
Cebu City
Danao
Lapu-Lapu
Mandaue
Naga
Talisay
Toledo
Kidapawan
Panabo
Samal
Tagum
Davao City
Digos
Mati
Borongan
Batac
Laoag
Candon
Vigan
Iloilo City
Passi
Cauayan
Ilagan
Santiago
Tabuk
San Fernando
Binan
Cabuyao
Calamba
San Pablo
Santa Rosa
San Pedro
Iligan
Marawi
Baybay
Ormoc
Tacloban
Cotabato City
Masbate City
Oroquieta
Ozamiz
Tangub
Cagayan de Oro
El Salvador
Gingoog
Bacolod
Bago
Cadiz
Escalante
Himamaylan
Kabankalan
La Carlota
Sagay
San Carlos
Silay
Sipalay
Talisay
Victorias
Bais
Bayawan
Canlaon
Dumaguete
Guihulngan
Tanjay
Cabanatuan
Gapan
Munoz
Palayan
San Jose
Calapan
Puerto Princesa
Angeles
Mabalacat
San Fernando
Alaminos
Dagupan
San Carlos
Urdaneta
Lucena
Tayabas
Antipolo
Calbayog
Catbalogan
Sorsogon City
General Santos
Koronadal
Maasin
Tacurong
Surigao City
Bislig
Tandag
Tarlac City
Olongapo
Dapitan
Dipolog
Pagadian
Zamboanga City
Zambales
Others
CITY / TOWN (SITE B)
COUNTRY (SITE B)
Please Select
Afghanistan
Africa
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua & Barbuda
Argentina
Armenia
Aruba
Asia
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, St.Eustat, Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean T.
British Virgin Islands
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Caribbean, the
Cayman Islands
Central African Republic
Central America
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Dem. Rep. of the
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor-Leste)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Europe
European Union
Falkland Is. (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Terr.
Gabon
Gambia, the
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey and Alderney
Guiana, French
Guinea
Guinea-Bissau
Guinea, Equatorial
Guyana
Haiti
Heard & McDonald Is.
Holy See (Vatican)
Honduras
Hong Kong, (China)
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Israel
Italy
Ivory Coast (Cote d'Ivoire)
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea Dem. People's Rep.
Korea, (South) Republic of
Kosovo
Kuwait
Kyrgyzstan
Lao People's Dem. Rep.
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao, (China)
Macedonia, TFYR
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Man, Isle of
Marshall Islands
Martinique (FR)
Mauritania
Mauritius
Mayotte (FR)
Mexico
Micronesia, Fed. States of
Middle East
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar (ex-Burma)
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North America
Northern Mariana Islands
Norway
Oceania
Oman
Pakistan
Palau
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Portugal
Puerto Rico
Qatar
Reunion (FR)
Romania
Russia (Russian Fed.)
Rwanda
Sahara, Western
Saint Barthelemy (FR)
Saint Helena (UK)
Saint Kitts and Nevis
Saint Lucia
Saint Martin (FR)
S Pierre & Miquelon(FR)
S Vincent & Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South America
S.George & S.Sandwich
South Sudan
Spain
Sri Lanka (ex-Ceilan)
Sudan
Suriname
Svalbard & Jan Mayen Is.
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Rep. of
Thailand
Timor-Leste (East Timor)
Togo
Tokelau
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Is.
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
US Minor Outlying Isl.
Uruguay
Uzbekistan
Vanuatu
Vatican (Holy See)
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
COUNTRY (SITE B)
CONTACT PERSON (SITE B)
CONTACT PERSON (SITE B)
CONTACT NUMBER (SITE B)
CONTACT NUMBER (SITE B)
SUBS EMAIL (SITE B)
SUBS EMAIL (SITE B)
SITE B GEO LOCATOR
Remarks/Special Instructions
Save
Submit
Clear Form
Should be Empty: