:: MOLA ::

Application

Please use the below form to apply broadband internet connectivity. * indicates required field.

Full Name:

Address:

Mobile:

Phone:

Fax:

Email:

Have landline(NTT) Phone:

Yes No

If you have NTT phone,
please specify owner name:

Network Choice:

NTT Yahoo BB

Broadband:

Hikari ADSL

ISP:

Fusion GOL OCN

*Note: Send the copy of allign card by Fax at +81-3-5439-7780

Please Contact at:
IT Media Services Mother Land Inc.
Phone: 03-5439-7782
Fax: 03-5439-7780
Email: ope@molatv.com, internet@molatv.com
URL: www.molatv.com/internet