SOA Delivery Request Form

SOA Delivery Request Form
TERMS & CONDITIONS*

I have read this form, understood its contents and consent to the processing of my personal data. I understand that my consent does not preclude the existence of other criteria for lawful processing of personal data, and does not waive any of my rights under the Data Privacy Act of 2012 and other applicable laws.
Name*

First NameLast Name
Account Number*
Phone Number*
Please enter a valid phone number.

Choose New Billing Method

Select one (1) only.
Email
SMS
All of the Above

Preferred Email Address:*
example@example.com

Preferred Cellphone Number*
Please enter a valid phone number.

Preferred Email Address:*
example@example.com
Preferred Contact Number*
Please enter a valid phone number.

Upload Valid Government ID or Company ID*

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I CERTIFY THAT THE DETAILS INDICATED ABOVE ARE TRUE AND CORRECT.

By signing up to PAPERLESS BILLING, I agree on the following:

I agree not to receive my Royal Cable Statement of Account through paper bills.

I agree not to return back to receiving my Royal Cable Statement of Account through paper bills.
Upload Photo of Signature*

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Date & Time
Should be Empty: