Ethernet Services Order Form

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.

*

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 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