Business ADSL2+ Broaband - Application Form

Business ADSL2+ Broaband – Application Form

ADSL2+ Business Application Form

Use this form to connect a new ADSL2+ business broadband service.

Step 1 of 3

Dealer
- Yes, 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 Information
Dealer Code*
Dealer Name*
Dealer Rep*
First Last
Organisation Details
Organisation Name*
ABN / ACN*
Name*
First Last
Position
Phone*
Email*
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Service Details
Service Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Activate ADSL2+ on this telephone number*
Do you already have an active ADSL2+ service on this number?*
- No
- Yes
Who is your current ADSL2+ service provider for this number?*
Minimum contract term*
Fee shown is exclusive of GST.
ADSL2+ Broadband Plan (24 Months)*
Monthly fee shown is exclusive of GST
ADSL2+ Broadband Plan (12 Months)*
Monthly fee shown is exclusive of GST
ADSL2+ Broadband Plan (1 Months)*
Monthly fee shown is exclusive of GST
Coverage Type*
- No, I do not agree to the surcharge.
- Yes, I agree to the surcharge for Extended Reach.
If your premises is outside our standard coverage area (e.g. Outer Metropolitan or Regional areas) we may be able to service your property via our "Extended Coverage" product. Extended Coverage incurs a $10.00 per month surcharge (ex GST).
If your service can be delivered using our standard coverage, this will always be the preferred option.
Total Monthly Fee (inc GST)*
Total Setup Fee (inc GST)*

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The Applicant accepts and agrees to the TRUECOM Standard Form of Agreement and ADSL2+ Broadband 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 may be required to provide technicians with access to your premises, for the purposes of installing the ADSL2+ Broadband 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 ADSL2+ Broadband service from the Main Distribution Frame to your required location.
Your Full Name*
First Last
SFOA can be downloaded here.*
- I agree to the terms and conditions above and have reviewed the standard form of agreement (SFOA)
SFOA can be downloaded here.
Name
This field is for validation purposes and should be left unchanged.

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Business ADSL2+ Broaband – Application Form

ADSL2+ Business Application Form

Step 1 of 3

Dealer Information

Organisation Details

Service Details