Application for Mobile HotSpot plan – 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

Mobile Hotspot UnlimitedMobile Hotspot 300GBMobile Hotspot 100GB

Mobile HotSpot
100GB LTE	¥7,800/month
300GB LTE	¥8,400/month
Unlimited LTE	¥8,800/month
Sign-up Fee	¥3,300
Deposit	¥20,000 Deposit will be refunded when the device is returned to HeroNet.
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.