BFM Telecoms - ADSL Order

ADSL INTERNET APPLICATION

Please make sure that you are not bound by a contract with your present provider before continuing. They may charge an early release fee.

Please select the appropriate service by ticking the box on the right.

* Required Fields

ADSL Plans *
	256 / 64	Shaped	15 GB / mth	$39.95
	512 / 128	Shaped	25 GB / mth	$59.95
	512 / 512	Shaped	35 GB / mth	$89.95
	1500 / 256	Shaped	35 GB / mth	$89.95
	8000 / 384	Shaped	35 GB / mth	$109.95

New Application or Transfer Request *
	New Application
	Transfer Request
	If transferring, who is your present provider?

Service Activation *
	New	$132
	Transfer (churn)	$45

Personal Details *

*Is This A Business or Personal Application?

*Customer / Company Name

A.B.N. (necessary for business)

*Primary contact name

Position (if company)

*Site Address line 1

*Site Address line 2

*State

*Post Code

*Phone line you wish your ADSL attached to

*Postal Address line 1 (if same as site write As Above)

*Postal Address line 2

*State

*Post Code

*Email Address (for billing)
If this address will change with the supply of this service, please remember to advise our Accounts Department of your new email address after our services have been commenced.

*Best Day Time Contact Number

Mobile Number

*Drivers Licence (I.D.)

*D.O.B.


Do you have an existing BFM Account?
*Requested Payment

BFM will send you out a Tax Invoice by email each month with a due date within 7 days of the invoice date. If you are a new customer your payment will be either credit card or Bank debit as approved by BFM.

To avoid the risk of On Line fraud, we do not request your Credit Card or Bank Account details in this On Line application. If you are a new customer please download a Direct Debit Authority HERE and post back to BFM Telecoms. If you already have an account with us our office will be in contact with you for your permission to add this charge onto your Direct Debit authority.

• I have read and agree to the Terms and Conditions HERE. • I understand that current rates are published online at www.bfm.net.au • I understand that the ADSL fee will be monthly in advance. • I understand BFM may perform a credit check upon application. • Though I am not under any long term contract, I will however agree to stay with BFM Telecoms for an initial 3 month contract and I will inform BFM if I decide to change my service.

AGREEMENT & AUTHORITY
I (name) - (Date) Aa certify that I have the authority to authorise this application and these details are correct. I understand that I have nominated BFM Telecoms (ABN: 36 004 636 874) to become my ADSL supplier and I authorise BFM to take any further action, including signing any additional documents on my behalf, to give effect to this charge.

ADSL Application

CHOOSE BFM TELECOMS AS YOUR

ADSL SERVICE SUPPLIER