NBN Broadband Application

NBN Business Application

Use this form to connect a new NBN Business Broadband service

Step 1 of 3

New or existing account?*
- I don't have an account
- I have an existing account number
Account Number
Account Name
Dealer Information
Dealer
- Yes, I am an active dealer (please tick)
Dealer Code*
Dealer Name*
Dealer Rep*
First Last
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
Connection Speed*
NBN Broadband Plan (12/1Mbps)*
NBN Broadband Plan (25/5 Mbps)*
Minimum contract term*
Do you require a NBN Telephone service?*
Note: If you are transferring an existing fixed line service, a $30.00 once off porting fee applies.

Call Rates for your NBNPhone Service
Local - $ 0.20 per call
National - $ 0.20 per min.
Mobile - $ 0.25 per min.
13/1300 - $ 0.35 per call
Do you require a NBN modem/router?

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The Applicant accepts and agrees to the BINARY NETWORKS Standard Form of Agreement and NBN 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 NBN 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 NBN 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.
Please sign this form to indicate your acceptance*
Please use your mouse or touchpad to sign this document. Press submit below when complete.
Email
This field is for validation purposes and should be left unchanged.

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NBN Broadband Application

NBN Business Application

Step 1 of 3

Dealer Information

Service Details