Voice2net Telecom - Connect

Business Details (Business Customers Only)
Business Name: ABN/ACN:

General Details (All Customers)
Full Name:

Address:
State: Postcode:

Mailing Address:
State: Postcode:

Phone Number: Mobile Number:
Fax Number: Date of Birth:
Licence Number: State of Issue:

Email Address:

Account Preferences:

Phone Line Connections and Provider Transfers
Phone Line:
Plan Requested:
Phone Number (Leave Blank for New Connection):

Service Address:
State: Postcode:

Mobile Phone Connections and Transfers
Mobile Phone:
Plan Requested:
Mobile Number (Leave Blank for New Connection):
Current Service Provider:
Account Number:

Internet Connections and Transfers
Internet:
Plan Requested:
Service Number (Leave Blank for New Connection):
New Pre-Configured Modem Required:
New Email Address:

By submitting this application, I agree that:
I have been given a chance to read, or have read the rates I will be charged for the services above, including activation and disconnection fees, if applicable. I have been given a chance to read, or have read the Terms and Conditions and Standard Form of Agreement, and agree to abide by these. I have been given a chance to read, or have read the Credit Agreement, and understand that acceptance of your application may depend on the result of a credit check. My application is deemed accepted at the time that my services begin billing with Voice2net telecom. I understand that I am responsible for any charges from my previous provider, if applicable, up until the date of transfer. I understand that I may be on a contract with my previous provider, and, if so, may be responsible for additional fees from them. Activation of an internet service is only possible if the product is available on my line. I understand that the remainder of my application will remain valid, even if the internet order is not successful. This application and authority is valid up to 30 days after the date of submission.

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