Application Form – ADSL2+ Broadband

Use this form to order a ADSL2+ Broadband service

Account Details
Account Number (if known)
Name*
First Last
Phone*
Contact Telephone Number
Email*
Enter Email Confirm Email
Service Details
Service Address*
Street Address Address Line 2 City / Suburb State Post Code
Billing Address*
Same as previous

Street Address Address Line 2 City / Suburb State Post Code

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Service Details
Service Telephone Number*
This is the telephone number the ADSL2+ broadband service will be activated on.
Download Quota*
Price includes GST
Contract Term (Months)*
Price includes GST

Early Termination Charge
If you cancel or disconnect the service, prior to completion of the minimum term, an early termination fee of $165.00 inc GST will apply.
ADSL2+ Modem/Router*
If you select this option, we will send you a preconfigured ADSL2+ compatible modem/router:

Billion BiPAC 7700N ADSL2+ 802.11N Broadcom All-in-One Modem Firewall Router

Price: $99.00 inc GST
P&H: $15.00 inc GST

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Click here to review the Standard Form of Agreement
Customer Acceptance*
- I have reviewed the Standard Form of Agreement (SFOA) and accept the terms and conditions of this service.

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Account Details