Astron Communication and Information Services Pty Ltd

Wireless Broadband 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 :


Plan ( Monthly Data Allowance )	24 month contract
1 GB	Yes
3 GB	Yes
5 GB	Yes
USB Modem / SIM Card	Free
Delivery Charge	Free

Yes – I agree to a 20% discount on the monthly fee for this Wireless Broadband plan by bundling with Astron’s Direct or Line Rental services. A separate application is needed if you are not our existing Direct or Line Rental customer.
Line Rental Services (Telstra Customer Only)	Switch from your current company to Astron	Phone Line Connection (Socket Exists) $59
	Connection with a technicians visit $125	New Phone line request $299

Acknowledgement:

I certify that the information provided above is true and I have the authority to register for this service as per sales materials provided to me. Astron will bill me for the service in accordance with Astron's current prices. The service will be provided subject to the provisions of Astron's terms and conditions available at www.astron.net.au. Astron, credit providers and the Carrier(s) may exchange call charging and 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.

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.