Application form for Internet in Otari Village
Otari Village Cable TV & Internet will shift to privatization from April 1, 2021. To use internet service, please submit
this application form to Phoenix Communications.

DateYYRenew□
the contract

MMDD

People who alredy have ONU \3,300

Please fill out this form and return it in the enclosed envelope.

Newapplication□

Are you already watching Otari CATV?

Installation Fee ¥36,300□（tax included）※In some cases, excess construction fee will be□

YesNoConsent for the Treatment of Personal DataConsentI agree to the treatment of personal information and the terms of use and apply for the "Internet Service in Otari Village"□ provided by Phoenix Club.

matters・Terms of use of Internet Service in Otari Village☑required

The details are as follows.

・ Treatment of Personal Information

http://www.phoenix-c.or.jp/◆Customer Information
Furigana

Gender

Guardian'sM

signatureF

ContactName（Company Name）

Name of Director※Minors are required parent consent agreement

印※Non-individual

Personnel(non-individual)-〒

Address

Date of※Date of incorporation

birth※Please write down

YYMMDD

the Name of thePhone Numberbuilding, like anapartment bldg. androom number (ifapplicable)

Address of use *if different from above〒Fax Number－Mobile Number＠E-mail address

If your email setting is set for rejecting mail reception, please set the domain for [@phoenix-c.or.jp] as a receivable domain. We will
send some important notices.

◆Payment method (Choose a way to pay)
Bank account（Bank transfers are to becompleted on the 27th ofevery month）

Please fill out the required items on the "Bank Account Transfer Request Form", stamp the form with your official
seal, and send back it to us.

□ Bank transfer setup takes about 1-2 months to complete. We will send you invoices by physical mail until
payments by bank transfer begin, so please make payment manually via these invoices until setup is complete.

We will send you an email with a credit card payment link to online applications for setting up credit card

Credit card

□ payment and changing card company or card number information.

Your credit card company will bill you for internet charges every month.
Business customers only. We will send you an invoice. Please transfer the money to the specified bank

Paying byinvoiceaccount by the deadline noted on the invoice.

□ Payment condition: Closings take place at the end of each month with payments made the following month.
- We will issue a payment invoice (¥220 per month）*Notice
It is NOT possible to use a credit card/bank account which carries a name different from that of the applicant.
If you change your payment method, be sure to choose one of the designated payment methods.

Continued on Reverse Side ▶

◆Internet Services

All prices include tax unless otherwise noted.

● Create a New Email Address of PXC （Free）※Required
FirstSecond@otr.pxc.jp

Third・Please write using half-width English numbers and letters, using more than 4 characters but less than 16
・You won't be able to get a e-mail address if the address is already used.
・If you need additional e-mail addresses, please contact us.

● Payment Plans （Please place a checkmark ☑ beside your desired plan）※Required
ServiceMenu

NetworkSpeed*(Maximum speed )

1G

1Gbps

200M

200Mbps

100M

100Mbps

10M

10Mbps1M

1Mbps

Toki-doki

100Mbps（ Two-tiered Flat Rate）

Basic Plan

Two-year Discount Plan

(12month contract)(two-year contract)

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¥6,270/month□□¥4,840/month*Maximum speeds are values based on¥7,480/month¥6,600/month¥5,720/monthtechnical specifications and do notSingle Month Plan□□¥8,470/monthSingle Month Plan can choose
temporary suspension. For the¥3,190/monthnecessarily represent actual usage¥2,090/month

Actual speeds may not improve even if

will not be required to pay forthe network speed is changed toyour internet service. However,speeds.

¥935～¥6,050/month

Maximum speed approx. 1Gbps,depending on devices, LAN cables, and（150MB～1GB）

duration of your suspension, you

you still must pay your monthly

network environment/status, etc.

lease charges. ¥360/month※Please let us know if●Two-year Discount Plan→ Contract made in units of two-years (automatically renews). Canceling outside theyou would like to

How to change contract renewal month will incur a cancellation fee. You can change plans from a Two-year Discount Plan tothe plans¥9,680/monthother plans for free at the contract renewal month.

stop/change your plan by●Basic Plan→Minimum term is 12 months. You can change plans from Basic Plan to other plans after 12 months.

the 20th of the final●Single Month Plan→You can change plans from Single Month Plan to other plans every single month.

month.。

● Optional services（Please place a checkmark ☑ beside your desired optional service）
Name

ChargeApplyi-Filter¥330/license

E-mail countermeasures¥220/email accountCountermeasures of Website¥200/account

050IP Phone Service¥330/phone number

Lease Router(IP Phone available)¥220/router

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Name

ChargeKaspersky Anti-Virus | 1 Month¥550/license

WPS Office¥385/license

Trendmicro Virus Buster | 1 Month¥495/license

Trendmicro Password Manager | 1 Month¥165/license

Fixed IP address（initial cost ¥2,000）¥1,100/accountApply□□□□□

NOTICE: In usual internet connection, a different IP address (dynamic IP address) is assigned by Phoenix Communications every time
you connect to internet. With Fixed IP Address Option, a fixed IP address will be assigned, dedicated for your personal use.

● When a visit is required for Setup ※Free for the first timers only□□□

Setup for internet
Setup for E-mailSetup for Optional Services

preferred date of visit

To adjust the visiting date, we will contact you at a laterーーーーーーーーーーーーーーーーーー●Phoenix Club Customer Center●
Phoenix Communications Co., Ltd.
Address 〒060-0001 Kita 1-jo, Nishi 7-3, Chuo-ku, Sapporo, Hokkaido
Phone：0120-911-528□ WEEKDAY □ WEEKEND □ BOTH

/ IP Phone：050-5520-2800

FAX:011-280-1667 / E-mail:staff@phoenix-c.or.jp

date.

TEL：050-5211-6333
Business hours：9:00～17:00 (weekday)
E-mail:staff@phoenix-c.or.jp
OTR_PXC_新規ver21.04.01