Network Service Application

CUSTOMER INFORMATION

Planname

Business Advantage Untimed

ABN/ACN*

Trading As (if applicable)*

Contact Name*

Date of Birth*		Drivers Licence No
Telephone*		Facsimile

Street Address*

State

Postcode

Previous Street Address (if at above address for less than 2 years)

State

Postcode

Postal Address (if different to above)

Years Trading
Position
Employer
Mobile*
Website

CUSTOMER SYSTEM & OTHER DETAILS

ISDN number ranges (Please Specify)

ISDN prime number of the range (Please Specify)

System Brand

System Model

System Maintainer

Contact Name

Telephone

System Reprogramming Required*

Yes No

SERVICE OPTIONS (Full Service)

SERVICE INFORMATION (Complete Supplementary Line Application Form if further space required)

I elect to have the telephone numbers in this section tagged as (Please tick one)

Listed or

Unlisted

Line No

Name

Description

PRIVACY STATEMENT

If you are an individual we will collect personal information about you. Clause 7 of the Standard Customer Agreement contain provisions about the use by TELEUS of your personal information. A summary of clause 7 of the Standard Customer Agreement is set out in the Summary provided with this Application. You should also read the provisions in the Standard Customer Agreement. By signing this Application you confirm that you have read and understood and you agree to those provisions.

If you would prefer that we do not use your personal information for direct marketing purposes, please tick this box (see clause 7.2(e) of the Standard Customer Agreement, a summary of which is set out in the Summary provided with this Application, for the way in which we will use your personal information if you do not tick this box).

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Local or national calls are included; make as many calls as you need to run your business !
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No flagfall on any timed calls.
Extremely competitive International rates.