Phone and Internet Order Form

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(Required)

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.

Billing Address

same as above

Service Address(Required)

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(Required)

First Last

Account holder name.

Date of Birth(Required)

Required for security purposes

Driver's Licence

Phone(Required)

This is used so that we can contact you.

Mobile

Email(Required)

Company Name

ABN / ACN

Section G. Shaping

Please select your option(Required)

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

Service Number(Required)

I have an existing telephone number

I need a new telephone line activated

Service Number(Required)

Enter your existing telephone number here.

Name on the account(Required)

This is the name on the account where your current telephone provider is billed to.

Your Account Number with current Telephone Provider(Required)

Enter your account number with the current telephone provider here. This number would appear on your bill.

We will assign a new number for you. Please move on to the next section.

Section J. Term

Choose The Contract Term(Required)

0 months

12 months

24 months

Section K. The Plan

Critical Information Summary

Choose Your Plan(Required)

Line rental included in this plan.

Option

MessageBank – $6.60 per month

Calling Number Display – $6.60 per month

Silent Number – $3.30 per month

Total Cost Upfront

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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