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NBN Order Form

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*
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 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
Router Purchase
- D-Link DVA-2800
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.
Consent to use my information*
- I confirm that I am authorised to provide the personal details presented and I consent to my information being checked with the document issuer or official record holder via third party systems for the purpose of confirming my identity.
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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