.................... APPLICATION form
User Information
Street Details
Billing Details
Last monthly bill 0-50 50-100 100-150 150-200 Higher
Services
Telephone numbers to connect (include area code) if you put a mobile number here we will contact you regarding getting a new sim card to you.
Recommended by
Current Carrier (eg Telstra, Optus etc)
Service Type (not including mobiles)
Pre-selected only for national, international calls & calls to mobile. You will not be billed for line rental
A full service customer for all local, national, international & calls to mobile and line rental
Please provide me information about an internet connection & a consultant to contact me about special deals that you may have
E-mail communication
Do you authorise us to contact you by email? Yes No
Acceptance of our Terms
Checking this box indicates that You have read and understand the Terms and conditions set out in the terms and condition page.