Super Fast ADSL2 Internet Order Form | Fantel

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Super Fast ADSL2+ Internet

This form is for super fast ADSL2+ 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. 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*

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 and bbx details as described below (50% bbx): 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 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
- TP-Link VG-5612
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*
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

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