EFM "LITE" Broadband - Application Form

EFM “LITE” Broadband – Application Form

EFM Broadband - LITE - Application Form

Use this form to connect a new EFM Broadband LITE Service

Step 1 of 3

Dealer
- I am an active Dealer
New or existing account?*
- I don't have an account
- I have an existing account number
Account Number*
Account Name*
Dealer
Dealer Code*
Dealer Organisation Name*
Representative Name*
First Last
Organisation Details
Organisation Name*
ABN / ACN*
Name*
First Last
Position
Phone*
Email*
Billing Address*
Street Address Address Line 2 City State Postcode Country

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Service Details
Service Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Please select a desired speed*
Price shown is exclusive of GST
Minimum Term - EFM Lite 8W*
Price shown is exclusive of GST

Early termination fees apply if service is cancelled or relocated prior to completion of the minimum contract term. Early termination fee is calculated by multiplying the monthly service fee by the number of pro-rata months remaining of the minimum term.
Minimum Term - EFM Lite4W*
Price shown is exclusive of GST

Early termination fees apply if service is cancelled or relocated prior to completion of the minimum contract term. Early termination fee is calculated by multiplying the monthly service fee by the number of pro-rata months remaining of the minimum term.
Available bandwidth is a conservative approximation only, actual experience may vary with distance from the exchange and the condition of the wires. As a guideline only, a 4 wire should deliver 10Mb up to approx. 1.2km and an 8 wire should deliver 20Mb up to approx. 1.7 km. We cannot guarantee any particular speed or availability at any location. If you require a specific speed, please consider our EFM STANDARD or EFM BUSINESS products.
Monthly Fee (inc GST)*
Setup Fee (inc GST)*

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The Applicant accepts and agrees to the TRUECOM Standard Form of Agreement, EFM LITE Service Description. The Applicant also agrees to the product specific details and pricing included in this application. The Applicant also confirms that he/she is 18 years of age or older. If the Applicant is a company then the person signing this form warrants that he/she is authorised to execute this Agreement on behalf of the company. You accept all responsibility for arranging, paying for and maintaining all cable required from the network boundary point, to the point where you wish to use the service. Billing of the service will commence within seven days of it being installed to the network boundary point, regardless of whether you have arranged any required additional cabling or not. ■ You will be required to provide technicians with access to your premises, for the purposes of installing the PSTN service. In most houses, the installation technician will either upgrade an existing telephone point; re-use a spare telephone point; or install a new telephone point. You agree that the type and location of the telephone point is at the installation technician’s discretion. ■ However in apartments, business premises and any other location with a Main Distribution Frame, you may need to arrange additional inbuilding cabling (at your expense) to bring the PSTN service from the Main Distribution Frame to your required location.
Your Full Name*
First Last
*
- I agree to the terms and conditions above and am authorised to enter into this agreement on behalf of the organisation.
Please sign this form to indicate your acceptance*
Email
This field is for validation purposes and should be left unchanged.

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EFM “LITE” Broadband – Application Form

EFM Broadband - LITE - Application Form

Step 1 of 3

Dealer

Organisation Details

Service Details