RESIDENTIAL

APPLICATION FORM

TERRASERV SERVICE APPLICATION FORM

NEW APPLICATION DATE: PREFERRED USERNAME: MR. MS. MRS.
CHANGE OWNERSHIP PREFERRED PASSWORD: TITLE:________________
CUSTOMER PERSONAL DATA
Customer Name Mother’s Maiden Name Birthdate (MM/DD/YYYY)
/ /
_________________________________________________________________
Last Name First Name Middle name
TIN NO. (MANDATORY FOR OR
ISSUANCE)

Customer Contact Info:

Email Address (mandatory):__________________________________________________________________________________
Mobile #(mandatory):____________________________________ Landline#:__________________________________________
COMPLETE ADDRESS:

CIVIL STATUS: CITIZENSHIP: ACR #: (for foreigners)

SINGLE OTHERS: _______ FILIPINO
MARRIED OTHERS: __________________

Contact Person:
Name:________________________________ Email Address:______________________________________
Mobile #:_____________________________ Landline#:__________________________________________

ID PRESENTED (Any 1 of the following primary IDs):

SSS/GSIS ID #:___________________________ Driver’s License ID#:________________________________
Passport #:_____________________________ TIN ID:____________________________________________
Company ID#:___________________________ Other primary IDs__________________________________
WORK and FINANCIAL INFORMATION
EMPLOYMENT STATUS Employer’s/Business Name Type of Business
___ Employed
___ Self- Employed
Employer’s/Business address Office Tel #:
___ Student

RATES and PACKAGES

PACKAGE NAME BURST SPEED UP TO DATA CAP MRC (VAT Inclusive)
PLAN 3500 Up to 30 Mbps Unlimited Php 3,500.00

PLAN 5500 Up to 50 Mbps Unlimited Php 5,500.00

An OTC (One-Time Installation Charge) of Php 4,800.00 shall be imposed by Terraserv for every new subscription.
24 months (2 Year) minimum contract Period
Note: 30% minimum speed at 80% service reliability

Requirements: Photocopy
● 1 valid (not expired primary ID) photocopy back to back (with 3 specimen signatures)
● Proof of Billing
My signature below signifies that all information stated herein are true and correct to the best of my knowledge.
Further, this signifies that I have read and understood the terms and conditions found at the back of this form.

CONFORME

_____________________________________
Subscriber / Authorized Representative
Signature over Printed Name

Contact Us: Customer Service 24/7

Landline: 02 8654-4419
Mobile #: +63 917 821-6402 | +63 917 810-5179 | +63 998 983-3621 | +63 998 545-8207 | +63 933 816-4510
[email protected] | [email protected]
Unit 2105 Prestige Tower F. Ortigas Jr. Road (formerly Emerald Avenue), Ortigas Center, Pasig City 1605
TERRASERV TERMS and CONDITIONS
1.DEFINITION OF SERVICES
For purposes of this Agreement, the term “Service” shall mean that TERRASERV Internet Service that you have selected. For purposes of this Agreement:
“Equipment” shall mean the modem / Customer Premise Equipment.
2. USER”S RESPONSIBILITIES
a. You acknowledge that you have the legal authority to enter into this agreement, being the duly designated representative of your unit / home and affirm that
the information you supply to us is correct and complete. You understand that for purposes of this agreement the term “YOU” shall mean the company that
you represent.
b. You understand that TERRASERV TECHNOLOGIES INC. relies on the information you supply and that providing false or incorrect information may result in Service
Provisioning delays or suspension or termination of your Service. You agree to promptly notify TERRASERV TECHNOLOGIES INC. whenever you’re billing
information changes.
c. That in order to avail of the INTERNET SERVICE, you shall subscribe to a TERRASERV TECHNOLOGIES INC. service for a minimum contract term indicated in this
proposal. TERRASERV TECHNOLOGIES INC. retains absolute ownership over the said Equipment to be provided to you as a consequence of such subscription
devices until the end of this contract period. In case of pre-termination, you agree to allow TERRASERV TECHNOLOGIES INC. to retrieve all TERRASERV
TECHNOLOGIES INC. – owned Equipment and other accessories installed at or within your premises and further agree to pay the necessary pre-termination
charges and equipment charges.
d. You undertake not to resell, assign, transfer, sublease, change or otherwise part with TERRASERV TECHNOLOGIES INC. Equipment. You further undertake not
to resell or make any commercial use of the Service without prior written consent of TERRASERV TECHNOLOGIES INC. If such violation is found, TERRASERV
TECHNOLOGIES INC. shall have the right to immediately disconnect/terminate the Service without obligation of serving a prior written notice.
e. TERRASERV TECHNOLOGIES INC. reserves the right to audit connections through ocular or electronic audit/inspections to enforce these or any and all other
provisions of this agreement.
3. AVAILABILITY OF SERVICE
a. The Service you select is available in selected areas : HIGHLANDS, GREENLANDS, AND MIDLANDS
b. TERRASERV TECHNOLOGIES INC. may, at any time, without notice or liability for damages in any case, restrict the use of the Service or limit it’s time of availability
in order to perform Service or Equipment maintenance activities. TERRASERV TECHNOLOGIES INC. shall however, immediately inform the Subscriber, whenever
feasible, of any operational problems or outages, and shall forthwith restore the Service upon such occurrence.
4. TERM AND TERMINATION
a. The subscription term begins on the date of your acceptance and ends after completion of the number of payment periods or as agreed in the Order Form (the
TERM). You should pay the amount as agreed upon in the form above or as supported by necessary documents (i.e. tax exemption, discount approval, etc.). The
rates for availed Add-Ons shall be billed on top of the monthly billable amount of the TERRASERV TECHNOLOGIES INC. for a period as indicated in the Order
Form. However, should you wish to terminate the Service before the expiration of the TERM, the request for service termination shall be subject to a 30-day
prior written notice to TERRASERV TECHNOLOGIES INC. In addition, you agree to pay pre-termination penalty using the formula provided for in paragraph “I”
hereof.
b. You shall pay TERRASERV TECHNOLOGIES INC. all the required charges set forth in this agreement or any revisions
c. Billing shall commence on date of activation, delivery and turn-over of TERRASERV TECHNOLOGIES INC. service(s), as indicated in the application form duly
signed by your authorized or designated representative(s).If, for any reason whatsoever, from the time you receive and signed the application form within
twenty four hours (24) from the date of endorsement of the form, we shall assume that the service is working, deemed accepted and billable. We shall therefore
take this as commitment on your part to pay/settle necessary billing components/charges for the service(s) in accordance with this signed Proposal with
conform and consistent with the provision as herein stated.
d. In the event that you fail to pay the charges referred to in the preceding paragraph within thirty (30) days from receipt of the TERRASERV TECHNOLOGIES INC.
billing statement. TERRASERV TECHNOLOGIES INC. shall issue a Notice of Disconnection at the end of the month following the unpaid billing. The Notice of
Disconnection shall require you to pay the outstanding charges within ten (10) calendar days from receipt of the said Notice of Disconnection
e. In any case, the termination of the TERRASERV TECHNOLOGIES INC. Service shall not prejudice TERRASERV TECHNOLOGIES INC. right to collect any unpaid
charges from the company you are currently representing.
f. Reconnection of permanently disconnected TERRASERV TECHNOLOGIES INC. Service shall require full payment of the outstanding balance and the corresponding
charges for the late payment, plus a reconnection fee of P 500, if the service had already been suspended for 3 months but not more than 6 months the amount
of P 4,800 shall be paid. All applicable one time charges shall be applied in case of reconnection of permanently disconnected lines.
g. It is understood that in addition to the monthly recurring charges (MRC), you shall pay the applicable Value Added Tax (“VAT”), or other applicable present or
future taxes that may be imposed by the government authority or required to be paid under this agreement as imposed by any governmental authority.
h. In case of contested bills, the amount due shall be fully settled with corresponding adjustment, if any, to be effected on the succeeding bill. Request for bill
adjustment, for whatever reason, shall be made in writing within thirty (30) calendar days from receipt of the billing statements/invoice from TERRASERV
TECHNOLOGIES INC. otherwise, request for billing adjustments made after the said period shall no longer be considered or entertained by TERRASERV
TECHNOLOGIES INC.
i. In the event that you pre-terminate the service before the contracted Term, you agree to pay TERRASERV TECHNOLOGIES INC. upon discontinuance of the
Service a termination fee based on the following formula:
PRE-TERMINATION PENALTY = (MONTHLY SERVICE FEE x REMAINING MONTHS WITHIN THE CONTRACT TERM)
j. If TERRASERV TECHNOLOGIES INC. does not receive any written termination advice from the Customer within sixty (60) calendar days before the end of Contract
term, the Contract shall be deemed automatically renewed for a period equivalent to the original term.
5. MANAGEMENT OF YOUR DATA AND COMPUTER
a. TERRASERV TECHNOLOGIES INC. shall not be responsible in protecting your telecommunication system against unauthorized external attacks/hacks. Any and
all damage, loss and prejudice, suffered by you by reason of such attacks/hacks shall be for your sole account. Thus, in the event of such occurrence, it is your
responsibility to investigate the incident with the assistance of TERRASERV TECHNOLOGIES INC., its affiliates and/or subsidiaries, if so requested.
b. You agree that the internet is not owned, managed by, or in any way affiliated with TERRASERV TECHNOLOGIES INC. and TERRASERV TECHNOLOGIES INC. has
no control over the information or materials accessed via internet through the use of the Service.
c. TERRASERV TECHNOLOGIES INC. does not warrant that the Service provided will be uninterrupted, error free, secure, or free from viruses.
6.REPAIR and REBATE
a .If TERRASERV TECHNOLOGIES INC. router is damage due to phenomenon or natural disaster event, TERRASERV TECHNOLOGIES INC. will replace the router, with
no additional cost to client.
b. If the router deployed by TERRASERV TECHNOLOGIES, INC. is defective, a replacement will be provided at no additional cost.
c. If phenomenon or natural disaster event, which affects the performance by either party, TERRASERV TECHNOLOGIES INC. can repair the affected client within
24 to 72 hours. Client need to call our customer service hotline numbers:
+63 917 821-6402 | +63 917 810-5179 | +63 998 983-3621 | +63 998 545-8207 | +63 933 816-4510 | 02 8654-4419
d. Once reported for repair and TERRASERV TECHNOLOGIES INC. did not take action within 24 to 72 hours, rebate will be applied, based on a daily rate.
e. If phenomenon or natural disaster continues and nonstop for 30 days and can’t repair the line, either party shall have the right to terminate the Service or these
terms and conditions, and the rights and obligations of the parties shall be resolved either by mutual agreement or by applicable law.