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Download printable version - NBN Form

Business NBN Application Form
Business NBN Application Form
PO Box 20 Chadstone 3148 Phone: 03 9885 4655

 Contact Information

Company:
Name:
Address:
Suburb:Postcode:
Phone:Fax:Mobile:
Email:Licence No:

 Plan Type

SpeedCapacityMonthly Fee
12M/1MUnlimited$77
25M/5MUnlimited$105
100M/40MUnlimited$132
   Notes:
  1. No basic setup cost
  2. A service fee of $35 applies where the speed of the service is altered.
  3. To determine service availability, check online at nbn co
  4. Minimum term 36 months
  5. Prices include GST
  6. Critical Information Summary

 Credit Card Direct Debit Authorisation

 VISA MasterCard American Express Other
Card Number:
Expiry:/
Card Holder's Name:

 Agreement

I agree that the above details are true and correct. I understand that my credit card will be debited for all set-up charges and monthly in advance for the access fee. Once connected, I agree to abide by the terms and conditions found at agreement or available on hardcopy upon request. This form must be signed if submitting by hardcopy. The signatory must be at least 18 years of age.
Please verify by ticking the "I'm not a robot" box before processing application
 I Agree

Download printable version - NBN Form