NEW Ethernet/ADSL/NBN Service Application Form

NEW INTERNET SERVICE APPLICATION FORM
WHEN TO USE THIS FORM: 1. You are a new or existing Webvault customer and would like to apply for NBN, ethernet or ADSL internet connectivity at a particular service location.
Need Help with this Form?Call 1300 139 927 Email: sales@webvault.com.au

Web: www.webvault.com.au
Account Information
Please enter your Webvault company account details for this new service. If you are a new Webvault customer you must complete the Online New Customer Information Form before proceeding with this service application.
Company or Business Name:*
The company responsible for paying for this new service.
Webvault Account Number (If Applicable)
For existing customers.
Contact Name for this Application*
Contact Email Address*
Contact Mobile Number*
Contact Telephone Number
Site Information
Site/End User Business Name*
The organisation who will be using this new service.
Your Order/Reference #
Site Service Address
Level/Floor #
Unit/Suite #
Street Address*
Suburb*
State*
Postcode*
Site Contact Person
The site contact is the person who will be available to provide access to the above premises for installers and technicians.
Site Contact Name*
Site Contact Mobile Phone*
Site Contact Email Address
Service Type and Speeds
Select Service Type*
Select the type of internet/connectivity service.
ADSL Service Options*

Annex-A Up to 24 Mbps / 1 MbpsAnnex-M Up to 24 Mbps / 3 Mbps
NOTE: The exact service speed of your ADSL service is dependent on your distance from the telephone exchange. Annex-M requires an approved Annex-M modem router to operate.
NBN Service Options*

12 Mbps / 1 Mbps25 Mbps / 5 Mbps25 Mbps / 10 Mbps50 Mbps / 20 Mbps100 Mbps / 40 MbpsFixed Wireless Plus
Is an NBN Termination Device Located at this Premise (for FTTP/Fixed Wireless Services)
Metro Ethernet Service (Fixed Bandwidth)*

100 Mbps / 100 Mbps250 Mbps / 250 Mbps500 Mbps / 500 Mbps1 Gigabit / 1 GigabitOther
Service Line Details for ADSL/NBN
EXISTING SERVICE?

Transfer my existing ADSL/NBN service from another providerBrand New Service
Current Provider*
SERVICE LINE (ADSL and NBN FTTN/FTTB Services Only)*

I require a NEW Service Line to be installed ($300 Ex-GST charge MAY apply in some cases)Use my existing telephone service line for this ADSL/NBN Service.Not Applicable (NBN FTTP/HFC/Fixed Wireless/Satellite Service)I am not Sure. Please contact me to discuss.
PSTN TELEPHONE LINE NUMBER*
NBN TELEPHONE NUMBER OPTIONS*

I do NOT require use of this Telephone Number any longer. DISCONNECT my PSTN Number!I would like to KEEP my Telephone Number and transition it to a Webvault voIP Service.
Service Contract and Fees
Please select the desired Contract Period and enter the applicable Monthly Service Fee and Setup Fee from your Webvault Internet Pricing Schedule. If you have been provided with a quotation please enter your quote reference number or the name of your Sales Representative.
Contract Period*
Monthly Service Fee $ (EX-GST)*
Service Setup Fee $ (Ex-GST) *
Quote Reference / Sales Representative:
Service Equipment Required
Select the ROUTER equipment required for your new service.*

Please supply a Cisco Managed Services Router (Charges MAY Apply)I will supply my own router.Please contact me to discuss my requirements.
Is a Rack Cabinet Located on Premise? (Required for Metro Ethernet Services)
ORDER ADDITIONAL EQUIPMENT (OPTIONAL)
Specify any additional equipment you would like to order for this site (Eg. Switches/Phones)
OTHER INSTRUCTIONS OR ADDITIONAL SERVICES (OPTIONAL)
Outline any additional services required or other instructions relevant to completing your service application. (Eg. MDF access instructions, special networking requirements, etc.)
Terms & Conditions of Service
You have read and understand the following terms and conditions applicable to this application.*

1. This service application is subject to a site qualification after this order is submitted, which may include a check on the availability of wires, cores or ports at your location. Submission of this application does not guarantee that Webvault can provide the service as ordered or at the price specified above. Webvault reserves the right to withdraw this application without any further obligation.2. If you are transferring an existing ADSL or NBN service from an another internet provider internet outage will occur during network changeovers. Webvault can provide an estimate in relation to the switch over date but cannot guarantee the precise date and time of the cut-over. Webvault takes no responsibility for any loss resulting from any outage of your internet service.3. Early termination of your service contract before contract expiry will result in an Early Termination Fee payable to Webvault. The Early Termination Fee for ADSL and ordinary NBN services is $150 Ex-GST. The early termination fee for Metro Ethernet services and NBN Enterprise Ethernet services is equal to the monthly service fee multiplied by the remaining number of unpaid months until the end of your contract expiry date unless otherwise specified in writing.4. Upgrading or transitioning an existing service to NBN or any other type of internet service during your service contract will result in a cancellation of the original service and an Early Termination Fee will apply unless otherwise specified in writing.5. In the event of a change of address Webvault does not guarantee that your service can be relocated. If your service can be relocated a Relocation Fee may apply. If a service cannot be relocated and must be cancelled during the original contract period an Early Termination Fee will apply.6. Webvault does NOT guarantee your service will operate correctly with your own router equipment. Webvault can provide approved equipment upon request.7. If ordering an ADSL, NBN FTTN/FTTB/Fixed Wireless service the exact speed of your service will depend on your distance from the exchange and the quality of your copper service line. These services are are provided on a "best-efforts basis" and Webvault cannot guarantee the exact speed of your service. NBN Fibre to the Node or Building (FTTN/FTTB) services are subject to the NBN co-existence period. NBN only guarantees a minimum attainable syncronisation speed of 12/1 Mbps for FTTN and 25/5 Mbps for FTTB. Ordinarily though service speeds are much higher.8. Webvault is not responsible for any loss of internet service resulting from faults relating to your service line or the operations of NBNCO or any other third party carrier. Webvault will address all internet faults with associated third parties on a "best-efforts basis."9. Failure to pay the monthly service or setup fees specified herein within 30 days of invoice may result in a suspension or cancellation of your service upon 14 days notice in which case an Early Termination Fee will apply to any services still within the contract period.10. Unless otherwise specified in writing, Webvault makes no statement in relation to this application as to the suitability of any of its internet services for your business operations, third parties or end-users.
Authorisation*

I am the authorised representative for the organisation listed at the top of this form and agree to proceed with this service application. I understand and agree to the above terms and conditions and enter into the selected service contract for the selected services.
Signed*
Enter your Full Name if Signing Digitally
Position*
Your Position in the Business
Application Date*

DayMonthYear
Todays Date
Should be Empty: