Application for Premium Mobile HotSpot – for Misawa Area Customers

User Information

Last Name *

First Name*

Middle Name

Date of Birth* YYYY/MM/DD

Gender*

MaleFemale

TEL (Cell) *

E-mail *

Mail Box# *

Squadron/Office name *

Duty phone *

DEROS/PRD * YYYY/MM

House numberIf you live off base

Employment Status

Active dutyDOD employeeContractorOther

Service　plan

【Rechargeable Plan】30GB【Rechargeable Plan】50GB【Rechargeable Plan】100GB【Rechargeable Plan】200GB【Rechargeable Plan】300GB【Rechargeable Plan】500GB【Half-yearly Plan】100GB【Half-yearly Plan】200GB【Half-yearly Plan】300GB【Half-yearly Plan】500GB

Inquiry

Pick-up at HeroNet office

Once you submit the form, HeroNet staff will contact you for contract details and scheduling pick-up date. Please note that there may be a waiting list depending on the availability of devices.

I read the HeroNet Internet Service Policy and agree to the terms provided above.

I confirm that the information given in this form is true, complete and accurate.