Shinbiro PPP Registration Form (FAX)

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し Name:___________________________

し Nationality:_________________________

し Registration Date(MM/DD/YY):_________________

し Birth Date(MM/DD/YY):________________________

し Home Address:______________________________________________________________

し HomePhone Number:__________________________________________

し Office Address:________________________________________________________________

し Office Phone Number:________________________________________

し Desired Login ID (1):________________ し Password(1):___________________

し Desired Login ID (2):________________ し Password(2):___________________

し Desired Login ID (3):________________ し Password(3):___________________

** Login ID must be more than 4 characters long and less than 8 characters.
** First choice of the Login ID will be most likely selected, unless it is already in use.

し Credit Card (Card Companies Only in Korea)(Circle One):

÷Visa ÷Master ÷Other :_______________ ÷Exp. Date (YY/MM/DD):__________________

** If you do not have a Korean Credit Card, a bank payable bill will be sent to you.
** You simply take this to any bank in Korea to pay the bill.

し Billing Address:______________________________________________________________________

** After completely filling out this form, fax this form to: FAX 031-738-6077
** Shinbiro helpdesk specialist (English only): 080-725-4357 (toll-free) OR
** Mail To :help-eng@shinbiro.com