Type Of Application:*
	Please supply me with a NEW phone connection
	Please transfer my phone from my present supplier to BFM Telecoms
	If transfering, please list present supplier
Phone Plans - Please Select One:*

	Home One	Rates as per PLAN page
	Corp. One	Rates as per offer
	Business One	Rates as per PLAN page

Please Select Business Personal

*Customer / Company Name

A.B.N. (if applicable-Necessary for Businesses)

*Primary contact name

Position (if company)

*Service Address - Line 1

*State

Please Select Queensland New South Wales A.C.T. Victoria Tasmania West Australia South Australia Northern Australia

*Post Code

Postal Address - Line 1

State

Please Select Queensland New South Wales A.C.T. Victoria Tasmania West Australia South Australia Northern Australia

Post Code

*Drivers Licence (I.D.)

*D.O.B.

Please write telephone number(s) below indicating your choice of BFM Telecoms as your preferred provider of pre-selectable and local telephone services.

Area Code

Number

Area Code

Number

Area Code

Number

Area Code

Number

Area Code

Number

Area Code

Number

Area Code

Number

Billing will be as per agreed method and BFM will send you out a Tax Invoice by email each month for your records. GST will be added to the billed amount. Direct Debit from nominated account will be within 7 days of the invoice date.

*Do you have an existing BFM Account?

Please Select Yes No

*Requested Payment

Please Select Direct Debit Credit Card Direct Debit Bank Account

Special Requests or Needs
Any additional services that you have attached to your existing Account?

• I have read and agree to the Terms and Conditions HERE.
• Line installation fee will be charged on all new lines at Telstra cost.
• Existing additional services (Message Bank etc) will be transfered and charged at Telstra cost.
• I understand that current rates are published online at www.bfm.net.au
• I understand BFM Telecoms 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.

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I (*name) - (*Date) certify that I have the authority to authorise this change and these details are correct. I understand that by nominating BFM Telecoms (ABN: 36 004 636 874) as the preferred carrier for the telephone number(s) above, BFM will become the carrier of choice for the International and National Long Distance Services, calls to Mobile and Local Calls, and any other pre-selectable services charged to this number. By further signing the Direct Debit Request you authorise the transfer of existing lines / new lines to BFM. I authorise BFM to take any further action, including signing any additional documents on my behalf, to give effect to this charge.