ADSL Service Application
       
Name:
    
Company:
   
ABN:    
Address: Street:
Suburb:
Post Code:
State:
 
E-mail:
    
     
ADSL attached on phone number:  
Name on the telephone bill:  
Address: Street:
Suburb: Post Code:
State:    
       
Login Name:
Password:
       Monthly Charges (Invoiced Quarterly)
  Connection Speed
256/64 kbps $70
512/128 kbps $100
1500/512 kbps $190
       All prices are GST inclusive.
       
Fixed IP address: Yes No ($10 per address/month)
  (Required if you have Email Server or VPN at your location)