Aria Telco Management NBN Form

Before proceeding, please confirm the following:*

I have checked www.nbnco.com.au to confirm NBN is available at my address.

Choose your NO CONTRACT monthly NBN plan...*

Lite - NBN 25/10Unlimited NBN Downloads, 20Mbps typical evening speed 7pm-11pm

$90.00AUD

Standard - NBN 50/20Unlimited NBN Downloads, 40Mbps typical evening speed 7pm-11pm

$95.00AUD

Premium - NBN 100/40Unlimited NBN Downloads, 80Mbps typical evening speed 7pm-11pm

$105.00AUD

Choose your new modem*

BYO modemModem required - $150 charged on first bill

Do you need a new phone service?*

Yes, please add a new number and call pack to my service for $35 per month. I understand this will include all local, national, 13/1300 and calls to mobiles within Australia.No, I do not require a phone service at this stage

Business Name (if applicable)

ABN (required if ordering under a Business Name)

Customer Name*

Date of Birth*

Contact Number*

Email Address (for billing purposes)*

Service Address*

Street Address

Street Address Line 2

CityState

Postcode

Do you have a current NBN service active at this address?*

YesNo

Modem Delivery Address (if different from above)

Delivery Address

Delivery Address Line 2

CityState

Postcode

Identification Required (attach below)*

Drivers LicencePassport

Attach file

Promo Code

Special Notes...

Account Name*

BSB*

Account Number*

Terms of Service*

I confirm the information provided is true and correct, and if ordering under a Business Name that I am authorised to place this order.I understand that the Supply of NBN and Charges once Aria Telco Management has received acknowledgement of my service being active, at which point I will be charged from this date onward, including a pro-rata charge on my first bill. I further understand that the standard turnaround time for an NBN service to be installed is 1-2 weeks, but that there are no guarantees offered in this regard.I understand and agree to the Aria Telco Management Standard Terms & Conditions. I understand that I can request a copy of the Standard Terms & Conditions prior to submitting this order by contacting Aria Telco Management on 1300 95 95 17 or info@ariatelcomanagement.com.auI request and authorise Aria Telco Management to debit payments from my nominated bank account as specified with this order on either the 7th or the 22nd of each calendar month, depending on which billing cycle I fall under.I understand and agree that Aria Telco Management may, at their sole discretion charge my account a $15 overdue account fee for a failed direct debit request due to insufficient funds or incorrect details provided. I understand and agree that should my account fall more than 7 days overdue my service may be suspended until full payment is received by Aria Telco Management. I understand and agree that should my account fall more than 30 days overdue my service may be terminated and a $100 fee payable for its reconnection.I understand that all pricing shown on this order form is inclusive of GST.

Signature*

Please verify that you are not a robot*

Aria Telco Management

Bank Account Details