Application for Data SIM Card 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

SIM 5GB

SIM Card
5GB/month	¥3,850/month
Sign-up Fee	¥3,300
Deposit	¥10,000 Deposit will be refunded when the device is returned to HeroNet.
SIM card needs to be returned to HeroNet after cancellation. ¥3,300 of non-returned SIM card fee will be charged if it is not returned.

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.