:: 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

NTT

Broadband:

Hikari ADSL

ISP:

Fusion GOL

*Note: Send the copy of allign card by Fax at +81-3-5308-1266

Please Contact at:
IT Media Services Mother Land Inc.
Phone: 03-5308-1268
Fax: 03-5308-1266
Email: ope@molatv.com,
URL: www.molatv.com/internet