ADSL 2 & Naked ADSL Line Activation Form 

ABN : 59 420 535 102       Business Name : Intertech Country

Telephone :

08 8723 6262

Address : 2 Beech Street, West Mt Gambier, SA 5290 Domain Name: http://www.icisp.net.au

 

 

Terms and Conditions : Please note:To use ADSL you must be within approximately 4 kilometres of the Telephone Exchange.

This Form must be completed for each ADSL Line Activation for each End user.

1.Any relevant charges will be applied to the Customer Account and are payable as per the Payment Terms specified on this Form.
End User Connection -
Full Name of End User : 		 
 Company Name of End User :   
ADSL Line Phone Number :
 

(           )  

End User Site Address :
 (Actual address where the
 telephone line is located)


 

 

 Address :

 

 City :

 

 Postcode:

                      State :     

Username:

   

Password:

 

Drivers licence no:

 

Date of Birth:

 

New Service :      

Existing Service :      

Cancel Service :    

Service Transfer from other Provider :  ( Provider Name:(                                                       ) churning

 $50.50
Cancellation Fee for Existing service contract :

 (applies if under 6 months)

   $97.50
Line Speed Change : $50.50

 ***** Line Activation Fee:

Once off fee

 $115.00

Upgrade from ADSL1

 $50.50

 No fault found: $257.50

relocation

$108.50

 

(prices as of 11 January2011 E&OE)
N.B. If you cancel your service during/after activation your activation fee is non refundable.
 * AUP-Acceptable Use Policy Once the AUP has been reached during a calendar month, the speed may be slowed to 64Kbps/64Kbps.   

 ADSL 2 - min. 6 months (prices shown are per month) - plans not shaped
ADSL 2 (12 GB) (Subject to AUP) - 12 Gig * per month  then slowed to 64Kbps  $56.50
ADSL 2 (25 GB) (Subject to AUP) - 25 Gig * per month  then slowed to 64Kbps  $64.50
ADSL 2 (50 GB) (Subject to AUP) - 50 Gig * per month then slowed to 64Kbps  $79.50
ADSL 2 (100GB) (Subject to AUP) - 100 Gig * per month then slowed to 100Kbps  $99.50

 

Naked ADSL - please note: this is only available on a 24 month contract

Service Transfer from Optus Network

 $50.50
Cancellation Fee for Existing service before contract ends :     $213.00

No fault found: $290.00

relocation $95.00 

 ***** Line Activation Fee:

Once off fee

 $177.00
Naked ADSL (12 GB) (Subject to AUP) - 12 Gig * per month  then slowed to 64Kbps  $58.00

Naked ADSL (25 GB)

 (Subject to AUP) - 25 Gig * per month  then slowed to 64Kbps  $65.50

Naked ADSL (50 GB)

 (Subject to AUP) - 50 Gig * per month then slowed to 64Kbps  $80.50

Naked ADSL (100GB)

 (Subject to AUP) - 100 Gig * per month then slowed to 100Kbps  $105.50

Wireless network info:

network name:                                            security key:   

 

 


SIGNED by ___________________________  Print Full Name________________________________

The signatory warrants that it is duly authorised to order these services on behalf of the ("Customer") named in this order. E&OE
No Contract, minimum connection required with us  is   6 months - Prices do not include set-up fees or cost of ADSL moden and filters. Payment can be made by Credit Card/Cheque/Cash/Direct Deposit/bpay    EXECUTED as an agreement on          /            /