BBX Offer Application Form | Fantel

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BBX Business Grade Internet Offer

This offer is only valid for BBX members only.

Section A. Existing Account
Existing Account Number:
If you're already a Fantel customer. Please enter your Fantel account number here.
Section B. Address
Enter the service address where the internet will be connected
*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Enter the address of where you want the National Broadband Network active.
Section C. Billing Address
If the billing address is the same above just put a tick in the checkbox, otherwise, please enter all fields below correctly.
Billing Address
- same as above
Service Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Enter the address of where you want the National Broadband Network active.
Section D. Contact Details
Details entered here will become the authorised account holder.
Your Name*
First Last

Account holder name.
Date of Birth*

Required for security purposes
Driver's Licence
Phone*
This is used so that we can contact you.
Mobile
Email*
Company Name*
ABN / ACN*
Section E. Payment Details
By filling out this section, you hereby request Fantel Pty Ltd (Fantel), until further notice, to arrange payment of your internet account, by debiting the credit card and BBX details as described below (40% BBX for the monthly service fee): You acknowledge that this request may be terminated at any time by Fantel or by notice in writing from you.
Card Type*
- VISA
- Mastercard
- AMEX
Name on card*
VISA Card Number*
Mastercard Number*
AMEX Card Number*
Expiry Date*
e.g if the expiry date is 05/17 just enter 0517 in this field.
CVV or CVC*
This is the 3 digit code at the back of your card
CVV or CVC*
This is the 4 digit code just above the AMEX card number.
Please enter your bbx details below.
Company Name on BBX*
Name on BBX Card*
BBX Card No.*
BBX Card Expiry Date*
If the date is 05/17, enter the expiry date in the following format: 0517
Section G. Shaping
Please select your option*
- Shape the connection to 128kbps/128kbps when data allowance is reached
- I accept excess data usage charges $11/GB thereafter.
Section H. Modem Router
Router Purchase
- D-Link DVA-2800
Section I. Service Details
Service Number*
- I have an existing telephone number
- I need a new telephone line activated
Service Number*
Enter your existing telephone number here.
Name on the account*
This is the name on the account where your current telephone provider is billed to.
Your Account Number with current Telephone Provider*
Enter your account number with the current telephone provider here. This number would appear on your bill.
We will assign a new number for you. Please move on to the next section.
Section J. Term
Acceptance of Contract Term*
- 24 Month Contract
To continue with the order, you must agree to the contract term.
Acceptance of Connection Charge*
- Existing Line Connection Fee
To continue with the order, you must agree to the Connection Charge. Where possible we will attempt to utilise existing lines for connection, however this may not be possible in all sites and a new line may need to be installed.
Acceptance of Connection Charge*
- New Line Connection Fee
To continue with the order, you must agree to the Connection Charge. Where possible we will attempt to utilise existing lines for connection, however this may not be possible in all sites and a new line may need to be installed.
Acceptance of Connection Charge*
- Existing Line Connection Fee
To continue with the order, you must agree to the Connection Charge. Where possible we will attempt to utilise existing lines for connection, however this may not be possible in all sites and a new line may need to be installed.
Acceptance of Connection Charge*
- New Line Connection Fee
To continue with the order, you must agree to the Connection Charge. Where possible we will attempt to utilise existing lines for connection, however this may not be possible in all sites and a new line may need to be installed.
Section K. The Plan
Choose Your Plan*
Your minimum monthly cost: $129.00 (60% Cash - 40% BBX)

Critical Information Summary
Your minimum monthly cost: $97.00 (60% Cash - 40% BBX)
Choose Your Plan*
$ 0.00
Section N. Comments
Your Message

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