WA Seniors NBN Form

Enter the address where the NBN will be connected

Your Name*

First Name Last Name

Contact Phone Number*

Email*

Street Address*

Address Line 2

Suburb*

Post Code*

State*

Contact Details

Details entered here will become the authorised account holder.

Date of Birth*

Driver's Licence Number

WA Seniors Card Number

Driver's Licence State of Issue

Select Your Speed*

WANBN50

WANBN25

WANBN100

Need a Modem?*

Yes

No

Minimum Commitment

Initial Upfront Payment

Payment

After submitting this form, you will be required to contact our Customer Service Team on 1300 720 207 to have your credit card put on file for your order to progress further.

Payment Authorisation*

I authorise Fantel Ltd to debit my credit card for any invoice issued by Fantel Ltd.

You will be charged for any once-off costs as well as a pro rata amount for the first month. You can change your payment details later by logging into your client account . Your ongoing monthly payment will be taken from your account at the time your invoices is generated.

Fantel Terms*

I have read, understood and agree to abide by Fantel’s Privacy Policy .

I.D. Verification Consent*

I confirm that I am authorised to provide the personal details presented and I consent to my information being checked via Rapid ID for the purpose of confirming my identity.

Initial Upfront Payment

WA Seniors NBN Appication

Enter the address where the NBN will be connected

Contact Details

Payment