Astron Communication and Information Services Pty Ltd

Great Saver Residential Plan - Application Form

For Office Use Only :
Agent No:			Application No :

Your Details			Office Address
Company Name:
Title:			Flat/Unit No:
First Name :			House No:
Middle Name:			Street Name :
Surname:			Suburb :
Position:			State :
Phone No. :			Post Code :
Mobile No. :			Email :
Fax No. :			ABN No. :
ID Type :			ID Number :
Other :			Expiry Date :

Phone Number(s) to be connect
	Area Code	Phone Number

Option 1 – Unlimited Fixed to Mobile calls	Option 2 – Unlimited International minutes (50 countries)
Yes - I like to sign up for the "unlimited Fixed to Mobile calls".	Yes - I like to sign up for the “unlimited Fixed to Mobile calls”
No - I am not interested	No - I am not interested

6 Month Contract

YES

Line Rental Services (Telstra Customer Only)	Switch from your current company to Astron	Phone Line Connection (Socket Exists) $59
Line Rental Services (Telstra Customer Only)	Connection with a technicians visit $125	New Phone line request $299

Note: Astron is not responsible for any errors or omissions published.

Declaration:

I certify that I have the authority to make this change and hereby apply to Astron Communications & Information Services to supply my telephone call services and acknowledge that: a) Astron will bill me for calls made from my telephone lines according to the applicable plan rates. b) The service will be provided subject to the provisions of Astron’s terms and conditions available at www.astron.net.au. c) Astron may select the carrier in order to supply the service. d) Astron, credit providers and the Carrier(s) may exchange call charging and Company account information. e) I understand that Astron cannot provide “Priority Emergency” service.

Full Service Transfer authorization:
I authorise Astron to make arrangements with my current telephone company for the transfer of lessee of my lines and accounts to Astron. I understand I will still be responsible to my current telephone company for any charges which are incurred and billed up to the date the transfer is effective. I acknowledge that I may surrender all incentives and benefits with my current telephone company. The telephone service number(s) will be transferred with their current status. I will contact my current telephone company in relation to providing services and any faults until the transfer is effective.

I/we certify that all the information supplied is true and correct.