GS Telecom - NBN / VOIP Registration Form

NBN / VOIP Registration Form

Internet Plan Selection

NBN Type

Internet Plan

Monthly Fee +

Service Type

Contract Period / Installation Fee

Modem

Terms	Notes
GST	GST not included
Cancellation Notice Period	30 Days
Early Termination Fee	$10 x remaining months
Installation Period	Depends on connection type

VOIP Plan Selection

VOIP Plan

Monthly Fee

Call Charges

ATA / Hardware Option

13/1300 calls charged 35c per call. Number porting fee $22. Separate ATA, if needed, is charged.

Extra Notes / Special Instructions

Personal Details

NBN Installation Details

Existing Phone Number

Address

Suburb

State

Post Code

Contact Details

Name

Mobile

D.O.B.

Email Address

Driver Licence

Business Details

Business Name

ABN

Credit Card Payments

Credit Card Type

Card Number

Name on Card

Expiry Date

CVC

Direct Debit Payments

Bank Name

BSB

Account Number

Account Name

Registration Details

Date

Sign physically below

Works with mouse, stylus, or finger on mobile.

I confirm that the information entered in this registration form is true and correct. I understand the selected plan fees, installation fee, cancellation notice period and early termination fee.

I agree to submit this registration form to GS Telecom.

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