Sign Up Form USER/CUSTOMER ID *CONNECTION TYPE *FIBERCAT-5 UTPONU MAC ADDRESS CABLE LENGTH *FIRST NAME *LAST NAME DATE OF BIRTH *NID NUMBER *ADDRESS *PHONE NUMBER *EMAIL *PACKAGE *DIAMOND-1500TKGOLD-1200TKSILVER-900TKBRONZE-600TKSOLDIER-500TKCONNECTION FEE *CONNECTION DATE *WebsiteSubmit