Internet only order form | Fantel

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Internet Only 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. Service Address
Enter the service address where the internet will be connected to.
Service Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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.
- same as above
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Section D. Contact Details
Details entered here will become the authorised account holder.
Your Name*
First Last
Account holder's 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 G. Shaping
Please select your option*
- Shape the connection to 256kbps/256kbps when data allowance is reached
- I accept excess data usage charges $11/GB thereafter.
Section H. Modem Router

D-Link DVA-2800

TP-Link VG5612
Router Purchase
- D-Link DVA-2800 $198.00
- TP-Link VG-5612 $143
Section I. Service Details

Enter the telephone number where the ADSL Internet 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*
- 1 months $ 199.00
- 12 months $ 99.00
- 24 months $ 0.00
Section K. The Plan
Choose Your Plan*
Your minimum monthly cost: $27.95

Critical Information Summary
Your minimum monthly cost: $39.95

Critical Information Summary
0
Your minimum monthly cost: $59.95

Critical Information Summary
Total Cost Upfront
$ 0.00
*If your premise is outside of our on-net service region, a $16.50 per month surcharge will apply.
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 authorise Fantel to direct debit my credit card the amount on the invoice at the time the invoice was generation.
Section N. Comments
Your Message

Internet
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