Ethernet Services Order Form

Ethernet Service Application

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 address where the service will be connected. The service will be installed at the Main Distribution Frame (MDF) of the premise.
Enter the address of where you want the National Broadband Network active.*
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*
DD slash MM slash YYYY

Required for security purposes
Driver's Licence
Phone*
This is used so that we can contact you.
Mobile
Email*
Company Name
ABN / ACN
Section H. Modem Router
or similar
Router Purchase
- Billion BIPAC7800NXL or similar
Section I. Service Details

Enter the telephone number where the Ethernet Service is to be activated on.
Service Number*
Enter your existing telephone number here and please include the area code.
Section J. Term
Choose The Contract Term*
- 12 months
- 24 months
- 36 months
Section K. The Plan
Choose Your Plan*
Your minimum monthly cost: $899.00

Critical Information Summary
Your minimum monthly cost: $485.00

Critical Information Summary
Your minimum monthly cost: $440.00

Critical Information Summary
Total Cost Upfront
$ 0.00
Section L. Agreement and Authorisation

By submitting this form you agree to the following:
*
- I have read, understood and agree to abide by Fantel's Terms and Conditions. I have also read and accept the Critical Information Summary.
*
- I authorise Fantel to direct debit my credit card the amount on the invoice at the time the invoice was generated.
Section N. Comments
Your Message

Ethernet Services Order Form

Ethernet Service Application

Section A. Existing Account

Section B. Address

Section C. Billing Address

Section D. Contact Details

Section H. Modem Router

Section I. Service Details

Section J. Term

Section K. The Plan

Section L. Agreement and Authorisation

Section N. Comments