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Order Form Dedicated Internet Local: Customer Information

This document is an order form for dedicated internet services from Biznet. It requests the following information: 1. Company and contact details for both technical and billing purposes at the customer and installation locations. 2. Service details such as requested speed and capacity, activation date, contract terms, and monthly/setup fees. 3. Installation information including addresses, contacts, interface types for both customer locations. 4. Additional notes, marketing details on how the customer learned of Biznet, and authorization for Biznet to provide the services. The document outlines Biznet's terms and conditions including providing 24/7 service, approval of customer equipment, and activation occurring after order form

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tejoajaa
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© © All Rights Reserved
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0% found this document useful (0 votes)
124 views5 pages

Order Form Dedicated Internet Local: Customer Information

This document is an order form for dedicated internet services from Biznet. It requests the following information: 1. Company and contact details for both technical and billing purposes at the customer and installation locations. 2. Service details such as requested speed and capacity, activation date, contract terms, and monthly/setup fees. 3. Installation information including addresses, contacts, interface types for both customer locations. 4. Additional notes, marketing details on how the customer learned of Biznet, and authorization for Biznet to provide the services. The document outlines Biznet's terms and conditions including providing 24/7 service, approval of customer equipment, and activation occurring after order form

Uploaded by

tejoajaa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 5

callcenter fax

Jakarta +62-21-57998888 Jakarta +62-21-5700580 Order Form


Bandung
Bali
+62-22-4267088
+62-361-221971
Bandung
Bali
+62-22-4267080
+62-361-232476
Dedicated Internet
Surabaya +62-31-5349388 Surabaya +62-31-5349389 Local
Sales Code :
Note Please provide detailed information so we can provision the service faster.
customer information
Company name/customer name

Address

Contact person For technical inquiries or installation, please contact


Contact title Technical contact person
Phone Phone
Fax Fax
Mobile Mobile
Email Email
billing information
Billing address

Billing contact person Billing contact phone


Billing contact email Billing contact fax
ID No (KTP/driver license) NPWP/Tax ID

For payment with credit card, please fill the information Expire date
Credit card type MasterCard/Visa
Credit card no
service information

IPv6 Addresing Yes No

We already applied Dual Stack system (IP v4 & v6) on our network and we highly recommend you to add IPv6
to your network.

Service capacity 3 Mbps (IX) & 10 Mbps (IIX) 5 Mbps (IX) & 15 Mbps (IIX)

10 Mbps (IX) & 25 Mbps (IIX) 10 Mbps (IX) & 50 Mbps (IIX)

10 Mbps (IX) & 100 Mbps (IIX) 25 Mbps (IX) & 100 Mbps (IIX)

50 Mbps (IX) & 100 Mbps (IIX)

Service request date Contract terms (min 12 months)

Monthly fee One time setup fee

installation information
Address - Node A Address – Node B

Biznet Order Form Dedicated Internet Local – Confidential Information


Page 1 of 5
Contact person – Node A Contact person – Node B
Name Name
Phone Phone
Mobile Mobile
Email Email

Interface type – Node A Interface type – Node B


[ ] Optical [ ] Electrical [ ] Optical [ ] Electrical

Additional installation information:

Preference Activation Date: Immediately Month/date/year


marketing information
How do you know Biznet?
[ ] Newspaper: _________________ [ ] Magazine: _________________
[ ] Radio: _________________ [ ] Billboard/Baliho
[ ] Biznet Website [ ] Search Engine: Yahoo/Google/Facebook
[ ] Referenced by friend/family/colleague [ ] Others: _________________

authorization
 We hereby confirm that the information above is true and agree to be bound by Biznet’s Terms and Conditions
 Biznet has the right to refuse this application without any explanation
 Biznet’s Terms and Conditions may change at anytime without prior notice
 For credit card payment, we hereby authorize Biznet to charge the credit card for service type we chose.

Signature & Company Stamp Print Name:

Date:

internal use
Account Executive Supervisor Branch Manager Provision Engineer

Signature Signature Signature Signature


Date Date Date Date

Please attach the following copies


Tax ID/NPWP for corporate customer, KTP/Passport/ID Card for personal customer

Credit Card (Front & Back) for payment with credit card only

Biznet Metro is the leading fiber optic network in Indonesia, now available in Jakarta,
Bali, Bandung and Surabaya. Visit www.biznetnetworks.com for details.

Biznet Order Form Dedicated Internet Local – Confidential Information


Page 2 of 5
Syarat dan Ketentuan Biznet Biznet’s Terms and Conditions
Pasal 1 - Fasilitas BIZNET Article 1 - BIZNET Facility
1. BIZNET sepakat untuk menyediakan Jasa Layanan dan fasilitas terkait 1. BIZNET shall provide the Services and related facilities (hereinafter
(selanjutnya disebut “Jasa”) sebagaimana tercantum dalam Formulir referred to as the “Services”), as stipulated in the Order Form, to be
Berlangganan Jasa, untuk dapat dipergunakan oleh PELANGGAN. used by CUSTOMER.
2. Jasa yang dimaksudkan diatas adalah layanan dedicated (1:1) untuk link 2. The Services of this product is dedicated for local link (IIX) and sharing
lokal (IIX) dan layanan up to untuk link internasional (IX). bandwidth (up to) for International link (IX).
3. Jasa yang disediakan BIZNET berdasarkan Perjanjian ini dapat digunakan 3. The Service provided by BIZNET under this Contract shall be available to
oleh PELANGGAN selama 24 (dua puluh empat) jam/hari (7 (tujuh) CUSTOMER on 24 (twenty four) hours per day (7(seven) day per week)
hari/minggu). basis.
4. Penyediaan fasilitas dan Jasa BIZNET akan dilakukan sesuai dengan 4. The installation of BIZNET Services and Facilities shall be subject to the
konfigurasi teknis yang telah disepakati. mutually agreed technical feasibility.
5. Terminal dan perangkat antar muka milik PELANGGAN yang akan 5. CUSTOMER owned terminals and the interface units connected to the
dihubungkan dengan perangkat/saluran BIZNET harus mendapat BIZNET Services and Facilities shall have prior approval from BIZNET.
persetujuan terlebih dahulu dari BIZNET. 6. Installation of BIZNET Services and Facilities shall be executed after
6. Penyambungan pelayanan BIZNET akan dilaksanakan setelah PELANGGAN CUSTOMER has signed the Application Form and paid the amount due at
menandatangani Formulir Berlangganan Jasa dan melunasi biaya yang telah inception.
ditentukan.
Article 2 - Service Activation
Pasal 2 - Aktifasi Layanan 1. The service will be installed after CUSTOMER has signed the Order Form
1. Instalasi Jasa akan dilakukan setelah PELANGGAN menandatangani and this service contract and pay the installation fee as stipulated in Order
Formulir Berlangganan Jasa beserta Perjanjian Berlangganan ini serta Form
membayar biaya instalasi sebagaimana tercantum dalam Formulir
Berlangganan Jasa. 2. The service will be activated after BIZNET Services and Facilities are
2. Aktifasi Layanan akan dimulai setelah fasilitas BIZNET siap dioperasikan dan ready for operation and confirmed by Installation Acceptance Letter
dinyatakan dengan Berita Acara Aktifasi yang ditandatangani oleh kedua signed by both parties.
belah pihak.
Article 3 - Term of Subscription
Pasal 3 - Jangka Waktu Berlangganan 1. The minimum “Initial Service Period” shall be valid for 12 (twelve
1. Minimal “Jangka waktu Berlangganan” Jasa periode pertama berlaku months) as stipulated in the Order Form (as Attach).
selama 12 (dua belas bulan) sebagaimana tertera pada formulir 2. After the expiration of the Initial Service Period, this Contract will be
berlangganan jasa (lampiran). automatically extended for successive twelve month periods. Unless
2. Setelah jangka waktu berlangganan berakhir, perjanjian ini dapat CUSTOMER want to terminate this contract than it shall provide BIZNET
diperpanjang masa berlakunya secara otomatis untuk dua belas bulan no less than 30 (thirty) days prior written notice of its intent to terminate
berikutnya, kecuali PELANGGAN menginginkan pengakhiran Perjanjian this Service Contract.
dengan pemberitahuan tertulis kepada BIZNET paling lambat 30 (tiga puluh)
hari sebelumnya.

Pasal 4 - Pembayaran Article 4 - Payment


1. CUSTOMER shall pay the installation fee and the first month fee before
1. PELANGGAN wajib membayar biaya pemasangan dan biaya bulan pertama the installation of BIZNET Services and Facilities as stipulated in order
sebelum dimulainya instalasi fasilitas pelayanan BIZNET sesuai dengan yang form, and this is not valid in the Renewal Period.
tertera di dalam formulir berlangganan, dan ini tidak berlaku di periode
perpanjangan.
2. CUSTOMER shall pay monthly charges as stipulated in the Order Form
2. PELANGGAN wajib membayar biaya langganan sebagaimana tercantum
not later than the 25th (twenty fifth) day of the current month.
pada Formulir Berlangganan Jasa ini selambat-lambatnya pada setiap
tanggal 25 (dua puluh lima) untuk bulan tagihan berjalan.
3. CUSTOMER will be charged for the late payment fee of 0.1% (zero point
3. PELANGGAN akan dikenakan denda keterlambatan sebesar 0.1% (nol koma one percent) from monthly fee per day.
satu persen) dari biaya bulanan untuk setiap hari keterlambatan pembayaran.

Pasal 5 - Hak dan Kewajiban Article 5 - Responsibilities


1. CUSTOMER will provide the necessary equipment required for BIZNET
1. PELANGGAN akan menyiapkan perangkat yang dibutuhkan, sehingga Services and Facilities to commence operation on activation date.
fasilitas dan pelayanan BIZNET dapat diaktivasikan sesuai jadwal yang telah 2. CUSTOMER responsible for the equipment that BIZNET had lent. And if
disepakati bersama. the equipment broken because of the negligent CUSTOMER’s, than the
2. PELANGGAN bertanggung jawab terhadap perangkat yang dipinjamkan oleh CUSTOMER must replace the equipment with the same equipment or
BIZNET, apabila terjadi kerusakan terhadap perangkat yang dipinjamkan pay the same amount of the price of the equipment.
akibat kelalaian PELANGGAN maka PELANGGAN akan mengganti
perangkat tersebut dengan perangkat yang sejenis atau diganti dengan uang
3. CUSTOMER shall not change the technical specification and
sejumlah harga barang tersebut.
configuration of BIZNET Services and Facilities or connect to the said
3. PELANGGAN tidak diperkenankan mengadakan perubahan terhadap
facilities in any other way without a written consent from BIZNET.
spesifikasi teknis, konfigurasi dan fasilitas layanan BIZNET, termasuk
menghubungkannya kedalam jaringan BIZNET dengan cara apapun, kecuali
4. CUSTOMER shall not connect the BIZNET network and/or facilities to any
atas ijin tertulis dari BIZNET.
public telecommunication network (PSTN) including but not limited to
4. PELANGGAN tidak diperkenankan untuk menghubungkan jaringan dan/atau
telephone, telex or data communication lines.
fasilitas BIZNET dengan jaringan telekomunikasi umum (PSTN) termasuk
namun tidak terbatas kepada jaringan telepon, teleks, atau komunikasi data. 5. CUSTOMER will grant access to BIZNET and or its agent to enter its
5. PELANGGAN akan memberikan izin kepada BIZNET atau wakilnya untuk facility and/or premises at any time to perform general maintenance and
memasuki fasilitas dan/atau lokasi milik PELANGGAN sehubungan dengan reparation of the installed facilities. BIZNET with written notice before
keperluan pemeliharaan dan perbaikan. dengan pemberitahuan tertulis
requesting access.
terlebih dahulu dari BIZNET sebelum meminta ijin untuk masuk.
6. BIZNET shall be liable for the maintenance and repair of any damage or
6. BIZNET bertanggung jawab terhadap pemeliharaan dan perbaikan atas service interruption on BIZNET transmission or facility. Should there be
kerusakan atau gangguan pada saluran dan fasilitas milik BIZNET. Apabila
any damage or interruption caused by the mistake, deliberateness or
kerusakan atau gangguan tersebut disebabkan oleh kesalahan, kesengajaan,
negligence of CUSTOMER, BIZNET reserve the right to collect a
atau kelalaian PELANGGAN, maka BIZNET berhak memungut biaya
maintenance fee.
perbaikan. 7. CUSTOMER shall be entitled to a refund for any services interruption.
7. PELANGGAN berhak memperoleh restitusi atas kerusakan atau gangguan
Compensation shall be computed as set forth in Article 6 or in the
yang terbukti bukan disebabkan oleh PELANGGAN. Kompensasi akan
attachment this Agreement and shall not apply in the case of Force
diberikan sesuai ketentuan yang terdapat di dalam Pasal 6 maupun di dalam
Majeure or should the interruption have been caused by Negligent of the
Lampiran dan tidak berlaku untuk kerusakan atau gangguan yang CUSTOMER’s and malfunction in the terminal(s) operated by
disebabkan oleh kelalaian PELANGGAN dan atau perangkat yang CUSTOMER and Force Majeure.
dioperasikan oleh PELANGGAN dan atau Force Majeure.
8. BIZNET tidak bertanggung jawab atas kebenaran, kerahasiaan dan atau
8. BIZNET shall not be liable for the accuracy, confidentially and or quality
kualitas informasi-informasi yang disalurkan melalui layanan BIZNET.
of the information transmitted through BIZNET service.
9. BIZNET tidak bertanggung jawab atas kerugian-kerugian PELANGGAN atau
9. BIZNET will not be responsible for any loss or damage to CUSTOMER
pihak ketiga yang timbul berkaitan dengan pengguna jasa BIZNET.
and or any third party related to the usage of BIZNET Services.

Signature
Biznet Order Form Dedicated – Confidential Information 3/7/2016 Page 3 of 5
Pasal 6 - Kesepakatan Tingkat Layanan dan Perhitungan Article 6 - Service Level Agreement (SLA) and
Restitusi Restitution Calculation
1. Jaminan atas tidak tersedianya Layanan BIZNET meliputi seluruh Jaringan 1. BIZNET SLA covers the entire BIZNET private Network including clean
Milik BIZNET sendiri termasuk listrik, system HVAC, system kabel, termasuk electricity supply, HVAC Systems, Fire Protection Systems, Surveillance
fasilitas yang berhubungan, yang minimum ketersediaan layananannya adalah Systems, network equipment’s, cabling system, including related facilities,
sebesar 99.8% (sembilan puluh sembilan koma delapan persen) (tidak will have monthly availability of minimum 99.8% (ninety nine point eight
termasuk jadwal pemeliharaan) percent) (excluding scheduled maintenance)
2. PELANGGAN berhak mendapat penggantian hingga 30% (tiga puluh persen) 2. CUSTOMERS are entitled to get refunds of up to 30% (thirty percent) of
dari jumlah Total tagihan dalam sebulan, jika BIZNET tidak mencapai Jaminan the monthly usage if BIZNET Delivery Service Level is not achieved
Layanan yang dijanjikan (tidak termasuk masa pemeliharaan). (excluding planned maintenance period).
3. Perhitungan Restitusi sebagaimana disebutkan pada ayat 2 (dua) diatas 3. The calculation for the refunds mentioned at article 2 above will be based
dihitung berdasarkan perhitungan sebagai berikut : on the following formula :

Rumus : (X * Y) / (Z * 99.8 %) Formula : (X * Y) / (Z * 99.8 %)


Penjelasan : Description :
X = Biaya bulanan sebelum PPN X = monthly fee before VAT
Y = Jumlah Waktu link yang putus (jam) Y = monthly cumulative downtime (hours)
Z = Waktu yang seharusnya diterima Z = respective month total hours
dalam satu bulan (jam) 99.8% = Biznet Delivery Service Level
99.8% = Tingkat jaminan Layanan BIZNET

4. Restitusi hanya dapat diberikan apabila pengajuannya dilakukan paling lambat 4. Any claim for a refund must be submitted by CUSTOMER to BIZNET
3 (tiga) bulan setelah terjadinya gangguan, jika pengajuan dilakukan setalah 3 within 3 (three) months of BIZNET’s failure to achieve its committed
(tiga) bulan maka restitusi tidak dapat diberikan. Delivery Service Level. CUSTOMER will not be eligible for any refund in
which the request for the refund is received by BIZNET after the 3 (three)
months submittal requirement period

Pasal 7- Pembatalan Article 7 - Cancellation


CUSTOMER shall pay a de-installation fee for the cancellation of its BIZNET
PELANGGAN akan dikenakan biaya pembongkaran peralatan yang terpasang
subscription if the cancelation is made prior the activation date.
apabila membatalkan berlangganan jasa BIZNET sebelum tanggal aktivasi.

Pasal 8 - Perpindahan dan Pengalihan Article 8 - Relocation and Transfer of Services


1. CUSTOMER reserves the right to request the movement of BIZNET
1. PELANGGAN dapat meminta perpindahan lokasi fasilitas BIZNET serta
penambahan kapasitas sepanjang teknis memungkinkan. Segala biaya yang facility and addition of the speed capacity if technically feasible. All cost
timbul akibat perpindahan lokasi serta penambahan kapasitas tersebut akan accruing from any request for movement and additional of speed capacity
dibebankan kepada PELANGGAN. will be borne by CUSTOMER.
2. All request related to the movement of BIZNET facility to a new location
2. Pemindahan fasilitas BIZNET yang telah terpasang ke lokasi lainnya akan
will be treated and charged as a new installation. Additional of speed
diperlakukan sebagai sambungan baru. Biaya berlangganan akan
capacity shall effect in subscription rates.
disesuaikan dengan penambahan kapasitas terpasang.
3. PELANGGAN dapat melakukan penurunan layanan setelah jangka waktu 3. Downgrade the Service can be done after the first initial service period
ended.
periode pertama telah selesai.
4. If CUSTOMER requests to downgrade BIZNET service before the end of
4. Apabila PELANGGAN meminta penurunan layanan BIZNET sebelum jangka
waktu periode pertama selesai maka PELANGGAN akan dikenakan denda the first period, then CUSTOMER must pay the Penalty for amount of
60% (sixty percent) x (initial service monthly fee - new service monthly
sebesar 60% (enam puluh persen) X (biaya bulanan layanan lama – biaya
fee) x remaining contract period
bulanan layanan baru) X sisa jangka waktu periode berlangganan.

Pasal 9 - Pemberhentian Perjanjian Berlangganan Jasa Article 9 -Termination of Service Contract Agreement
1. BIZNET berhak melakukan pemutusan sepihak tanpa melalui pemberitahuan 1. BIZNET has right to terminate the service, if until 7 (seven) days from the
apabila dalam waktu 7 (tujuh) hari setelah jatuh tempo pembayaran due date, CUSTOMER neglected his obligation to pay, without any
PELANGGAN lalai dalam memenuhi kewajiban pembayarannya. confirmation.
2. Perjanjian ini akan berakhir apabila terjadi pemutusan dan/ atau
pembongkaran fasilitas BIZNET sebagaimana tersebut dalam Pasal 3. 2. This Contract will be terminated if BIZNET disconnect and/or dismantle
3. Apabila layanan BIZNET dihentikan oleh PELANGGAN, dengan sebab BIZNET’s facility pursuant to Article 3.
apapun sebelum berakhirnya jangka waktu perjanjian periode pertama
sebagaimana tersebut dalam Pasal 3, PELANGGAN berkewajiban melunasi 3. If CUSTOMER terminates the Service, as of any cause prior to the
sisa biaya bulanan pada periode tersebut, ditambah dengan biaya expiration of the Initial Services Period as stipulated In article 3,
pembongkaran fasilitas BIZNET yang terpasang. CUSTOMER agrees to pay the monthly fee for the period remaining in the
4. Seluruh tagihan termasuk sisa kewajiban pembayaran bulanan harus Initial Services Period or the extended period including applicable de-
dibayarkan oleh PELANGGAN dalam waktu 30 (tiga puluh) hari kepada installation fee.
BIZNET secara keseluruhan pada saat berlangganan jasa BIZNET berakhir.
5. Kedua belah pihak sepakat untuk mengesampingkan ketentuan Pasal 1266 4. Any outstanding balance including all remaining monthly fees applicable
Kitab Undang-undang Hukum Perdata Indonesia, sehingga pembatalan to the remaining Initial Services Period shall be paid by CUSTOMER to
perjanjian ini bersifat final berdasarkan permohonan tertulis kepada pihak lain BIZNET within 30 (thirty) days of CUSTOMER’s receipt of a correct
sesuai dengan persyaratan dalam Perjanjian Berlangganan Jasa ini. invoice from BIZNET.
5. Both parties agrees to waive provision of Article 1266 of the Indonesian
Civil Code, there termination of this contract shall be final entirely by
written notification to the other party in accordance with the terms and
conditions of this Service Contract Agreement.

Pasal 10 - Force Majeure Article 10 - Force Majeure


Bilamana dalam menjalankan kewajiban yang tertera dalam Perjanjian ini tidak If performance of this Contract or any obligation hereunder, is prevented,
dapat dilaksanakan, terhambat atau terganggu oleh sebab, akibat atau kondisi restricted or interfered with by any act or condition beyond the reasonable
yang berada diluar kendali, BIZNET wajib memberitahukan keadaan tersebut control, BIZNET will give prompt notice to CUSTOMER and be excused from
secepatnya kepada PELANGGAN dan dapat dibebaskan dari seluruh atau such performance to the extent of such prevention, restriction or interference.
sebagian kewajiban yang harus dilakukan, sepanjang hal tersebut diakibatkan oleh During the period of such non-performance, any and all charges, fees, or other
hambatan atau gangguan tersebut. Dalam masa tidak terlaksananya kewajiban payments arising out of or in relation to any Services not being performed will be
tersebut, seluruh biaya dan tagihan yang berkaitan dengan layanan yang diberikan suspended.
dapat ditangguhkan.

Pasal 11 – Penyelesaian Perselisihan Article 11 - Settlement of Dispute


1. Apabila terjadi perselisihan antara PARA PIHAK yang berhubungan dengan 1. Should there be any dispute between the PARTIES, related to this
perjanjian ini maka akan diselesaikan melalui musyawarah. Agreement; the PARTIES agree to settle the dispute through amicable
2. apabila penyelesaian melalui musyawarah tidak bisa tercapai maka PARA discussion.
PIHAK sepakat untuk menyelesaikannya melalui Badan Arbitrase Nasional 2. In the event the dispute cannot resolve through amicable discussion the
Indonesia (BANI), dengan mengikuti semua peraturan atau prosedur BANI PARTIES agree to settle through Indonesian National Arbitration Board
berdasarkan ketentuan hukum negara Republik Indonesia. (BANI) according to procedural rules of BANI with based on Republic of
3. Selama proses penyelesaian oleh BANI maka Hak Dan kewajiban PARA Indonesian’s Rules.
PIHAK akan tetap dilaksanakan hingga BANI mengeluarkan putusan yang 3. During the Process in BANI the right and obligation of the PARTIES shall
mempunyai kekuatan hukum yang tetap continue until the Dispute has been settled with absolute legal effect.

Signature
Biznet Order Form Dedicated – Confidential Information 3/7/2016 Page 4 of 5
Pasal 12 - Lain-lain Article 12 - Miscellaneous
1. Perjanjian Berlangganan Jasa ini dapat ditambah, dimodifikasi, dan 1. This Service Contract Agreement may be amended, modified, varied, or
disesuaikan atas persetujuan kedua belah pihak. supplemented by written agreement.
2. Lampiran-lampiran dalam Perjanjian ini merupakan bagian yang tidak dapat
dipisahkan dan mempunyai kekuatan hukum yang sama. 2. Any attachment to this Agreement shall be treated as part of the
3. Bila terjadi perbedaan pengertian antara teks bahasa Inggris dan teks bahasa Agreement and shall have an equally authentic power as the Agreement.
Indonesia dalam Perjanjian Berlangganan Jasa ini, maka teks bahasa 3. In case of discrepancy between the English text and Indonesian text
Indonesia yang berlaku herein, the Indonesian text shall prevail.

Signature
Biznet Order Form Dedicated – Confidential Information 3/7/2016 Page 5 of 5

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