PO Box 20

Business ADSL2+/ADSL/ANNEX M Application Form

 Chadstone  3148
Phone:  03 9885 4655

 Contact Information

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

 Connection Information

Service Phone Number:
   Notes:
  1. Service Phone Number is the phone line on which the ADSL will be installed.

 Plan Type

AnnexM Speed Capacity Monthly Fee
20,000k/3,000k UNLIMITED $80
   Notes:
  1. A $120 establishment fee applies to new ADSL/ADSL2+/AnnexM services.
  2. A $50 establishment fee applies to services churning from another ISP.
  3. For Naked DSL+, add $25 per month.
  4. ANNEX M will be supplied where available.
  5. Minimum term 12 months.
  6. All prices include GST.
  7. Speeds are maximum attainable. Actual speeds achieved on your service will vary depending on several factors including distance from the local exchange.
  8. Critical Information Summary

 Optional ADSL Hardware

 Netcomm EM1550 ADSL+ In-Line Splitter/Filter - one required for each existing device connected to the same line as the ADSL service. Note:Netcomm routers do not include filters $ 18 each 
 Netcomm NB604N Wireless N300 modem/router $ 95 each 

 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 i.net.au/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.
 I Agree                     Signature                             Date