Astron Communication and Information Services Pty Ltd

International Cap Plan - Application Form

This form must be signed by the Telstra account holder in your household.

Your Details			Your Address
Company Name:
Title:			Flat/Unit No:
First Name :			House No:
Middle Name:			Street Name :
Surname:			Suburb :
Date Of Birth:			State :
Home Phone:			Post Code :
Mobile Phone:			Email :
Work Phone:			ABN No. :
ID Type :			ID Number :
Other :			Expiry Date :
Employer Name :			Occupation :

Telephone Services : Is the telephone in your name ? Yes No
Current Carrier Telstra Optus AAPTPrimus Other

Override Service you are using ? 1414 1428

Do you authorise Astron to shift your override code services from present company to Astron ?
Yes No


Phone number(s) :	Override Direct
Phone No. 1	Yes Yes
Phone No. 2	Yes Yes
Phone No. 3	Yes Yes

Remark :

Most frequently called countries 1. 2. 3.

Acknowledgement:

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.
If applicable, I authorise Astron to charge my credit card for all amounts owed to Astron when those amounts become overdue and which I have not disputed by giving Astron written notification of the dispute.
Note: Astron is not responsible for any errors or omissions published.

Credit Card Type :

Visa Master Diner Amex Bank Card

Card Holder's Name :

Card No. :

Expiry Date :

I accept the Terms and Conditions of Astron.