Locall Australis ADSL Order

Service Details

Account Setup: New activation Churn from current provider

ADSL Plan : High Speed Internet 100 $59.95 p/m

Contract / Setup Fee:

ADSL Phone Number: (with area code)

Service Address:

Town/Suburb:

State:

Postcode:

Time at Current Address: years

Previous Address:

Optional Modem & other Hardware:

EM1100 in-line Filter $9.95	EM1550 ADSL 2 Splitter/Filter $16.95
Netcomm NB6 Modem $65	Netcomm NB6+4 Modem $99
Netcomm NB6+4W $125	Netcomm NB6+4Wn $225
Netcomm NB9MAXX $235
$20 for shipping & configuration

Optional Phone Connection

Please complete if you wish to bundle a new or existing Phone service with your ADSL.
A discount of $5 off your monthly bill is applicable with all our ADSL plans while bundled with your phone.

Telephone Services Required: Not at this time Yes, I do need phone

Your Information

Title: eg Mr, Mrs, Ms, Dr etc

First Name:

Middle Name:

Last Name:

Date of Birth:

Drivers License:

Mobile Phone: (for SMS Alerts Service)

Email Address:

Are services required for a Company or Business?

Company or Business Services: No Yes

Please tick this box to acknowledge you have read and agree to the Locall Australis Credit Conditions.

1. Agreement that Rivertel Pty Ltd may seek consumer credit information (Section 18K (1) (b) Privacy Act 1988).
If Rivertel Pty Ltd considers it relevant to assessing my/our application for credit, I/we agree to Rivertel Pty Ltd obtaining from a credit reporting agency a credit report containing personal credit information about me/us in relation to credit provided by Rivertel Pty Ltd.
2. Exchanging information with other credit providers (Section 18N (1) (b) Privacy Act 1988).
I/we agree to Rivertel Pty Ltd obtaining personal information about me/us from other credit providers, whose names I/we may have provided to Rivertel Pty Ltd or that may be named in a credit report, for the purpose of assessing my/our application for credit, made to the company.
3. Listing credit default information (Section 18E (1) (b) (vi) Privacy Act 1988).
I/we agree that if I/we default on our terms of subscription, Rivertel Pty Ltd may list information about my/our credit default with a credit reporting agency.

Is your Postal Address different from Service Address?: No Yes

Payment Method

Charges are billed in advance with one month security deposit held as credit towards your final account balance.

Payment Type: Mastercard Visa BPay/Invoice

Credit Card payments attract a 1.25% surcharge

Name on Card:

Card Number:

Card Expiry:

CCV: Last 3 numbers on back of card

Account Information

Nominate a username (max 16 characters - lower case only, no symbols or special characters) and password (max 8 characters - can be upper & lower case but no symbols or special characters).

Australis Email: Tick if Australis email address is required

Username:

Password:

Please enter any other information you wish to include with your order:

How did you find us:

Terms and Conditions

Please tick this box to acknowledge you have read and agree to the Locall Australis Terms and Conditions (open in new window).

Tasmanian Surcharge

I am a Tasmanian customer & I am aware of the surcharge applied to new Tasmanian ADSL connections

Promotion & Reseller

Please enter your Promotional Code, Reseller Reference Number or details of referring account (if applicable):

Order Locall Australis - High Speed Internet 100