Application for Premium Mobile HotSpot – for Misawa Area Customers

User Information

Last Name *

First Name*

Middle Name

Date of Birth* YYYYMMDD

Gender*

MaleFemale

TEL (Cell) *

E-mail *

Mail Box# *

Squadron/Office name *

Duty phone *

DEROS/PRD * YYYYMM

House numberIf you live off base

Employment Status

Active dutyDOD employeeContractorOther

Monthly plan

【Premium】Mobile HotSpot 500GB【Premium】Mobile HotSpot 300GB【Premium】Mobile HotSpot 200GB【Premium】Mobile HotSpot 100GB

Premium Mobile HotSpot Plan​
500GB LTE	¥8,800/month
300GB LTE	¥7,700/month
200GB LTE	¥6,600/month
100GB LTE	¥5,500/month
Sign-up Fee	¥3,300
Device (Purchase plan)	¥17,900
First months fee will be prorated, but cancelling month WILL NOT be prorated. Tax included in prices.

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.