Application for Mobile Internet – for Kyotango Area Customers

User Information

Last Name *

First Name*

Middle Name

Date of Birth* YYYYMMDD

Gender*

TEL (Cell) *

E-mail *

Mail Box# *

Squadron/Office name *

Duty phone *

DEROS/PRD * YYYYMM

House numberIf you live off base

Employment Status

Monthly plan

Inquiry

Pick-up at your local housing agency

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.

Yes, I would like to apply for HeroNet Internet service.