NBN Order Form

This form is for NBN (National Broadband Network) 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. 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

Enter the address of where you want the National Broadband Network active.

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

Enter the address of where you want the National Broadband Network active.

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 E. Modem Router

D-Link DSL-X1852E

Router Purchase

D-Link DSL-X1852E

Section F. Term

Choose The Contract Term(Required)

1 months

Section G. The Plan

Choose Your Plan(Required)

Critical Information Summary

Total Cost Upfront

Your Comments

Section J. Agreement and Authorisation

By submitting this form you agree to the following:

Battery Backup Service(Required)

I have read and understood the obligations of the Backup Battery which is outline in http://www.nbnco.com.au/battery. And I agree that it is up to me to replace the battery when it needs replacing.

Fantel Terms(Required)

I have read, understood and agree to abide by Fantel's Terms and Conditions.

Payment Authorisation(Required)

I authorise Fantel to direct debit my credit card the amount on the invoice at the time the invoice was generation.

I.D. Verification Consent(Required)

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.

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