NBN Order Form | Fantel

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NBN Application Form

This form is for NBN (National Broadband Network) internet access.

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
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 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: 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.
Section F. 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 G. Modem Router

D-Link DVA-2800

TP-Link VG5612
Router Purchase
- D-Link DVA-2800
- TP-Link VG-5612
Section H. Term
Choose The Contract Term*
- 1 months
- 12 months
- 24 months
Section I. The Plan
Choose Your Plan*
Critical Information Summary
Critical Information Summary
Critical Information Summary
Total Cost Upfront
$ 0.00
Your Comments
Section J. Agreement and Authorisation

By submitting this form you agree to the following:
Battery Backup Service*
- I have read and understood the obligations of the Backup Battery which is outline in http://www.nbnco.com.au/battery. And I agree that it is up to me to replace the battery when it needs replacing.
Fantel Terms*
- I have read, understood and agree to abide by Fantel's Terms and Conditions.
Payment Authorisation*
- I authorise Fantel to direct debit my credit card the amount on the invoice at the time the invoice was generation.

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