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Application Date:
Recipient Address:
Recipient Name:
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| WiFi Rental Fees | | Country Plan | Units | Amount |
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| Subtotal for WiFi Rental | NT$0 |
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| Optional Add-ons | | Optional Add-ons | Units | Amount |
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| Subtotal for WiFi Rental | NT$0 |
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| Other Fees | | Other Fees | Amount |
|---|
| Subtotal for WiFi Rental | NT$0 |
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Total PaymentNT$
※ If individual amounts need adjustment, they will be modified based on the total amount, which may differ from the detailed amounts.
※ Subtotal amounts may reflect special promotions or discounts.