WebShield - Welcome

BROADBAND

Apply for Webshield Internet Services

PERSONAL DETAILS

Please note : Name must be that of the phone account holder and the name must be as it appears on the phone bill.

First Name:

Last Name:

Phone No:
(Line to be used for Broadband)

Company:
(if not for private use)

PHYSICAL ADDRESS

Street Address Line 1:

Street Address Line 2:

Suburb:

State:

Post Code:

BILLING ADDRESS (If the same as above, please leave blank)

Street Address Line 1:

Street Address Line 2:

Suburb:

State:

Post Code

CONTACT DETAILS

Day Phone No.:

Night Phone No.:

Fax:

Current e-mail Address:

BILLING/PAYMENT DETAILS

Credit Card Details:

As we are still testing our billing system we will ring you for your credit card details rather than requiring you to enter them here.

Internet Account

PERSONAL ACCOUNT DETAILS

Preferred Username:

Selected Password:
(6-12 characters)

Email Accounts (up to 5 accounts) (just letters & numbers, no .-& symbols etc)		(6-12 characters)
Preferred Address 1	Selected password 1
Preferred Address 2	Selected password 2
Preferred Address 3	Selected password 3
Preferred Address 4	Selected password 4
Preferred Address 5	Selected password 5

SELECTED PACKAGE

Safetynet:

Weave Your Own Web:

Email Plus:

SELECTED PAYMENT PLAN

256 / 64
(5x faster than dial up)

512 / 128
(10x faster than dial up)

1500 / 256
(30x faster than dial up)

512 / 512
(10x faster than dial up)

Light

$49.95 for 1Gig

TBA

Standard

$59.95 for 12 Gig

Express

$79.95 for 20 Gig

Ultimate

$115.95 for 30 Gig

Extreme

$125.95 / 30 Gig

ADDITIONAL CHARGES

First Time on Broadband
Line Activation Fee

$139

Billion 5100

Billion 7100
Wireless

Voice enabled router
(for internet calls)

Modem Router

$100 rrp

$190 rrp

$210 rrp

PLEASE NOTE

1. WebShield will provide preconfigured modem routers as part of the setup process
2. The Telstra charge for termination of a broadband connection before 6 months is $87
3. There is no excess download fee, but speeds are slowed to the following . . .

256/64

33kbs

512/128

64kbs

1500/256

64kbs

512/512

64kbs

FAST CHURNING FROM AN EXISTING ISP

Previous ISP

Please fill in if you require fast churning from your previous service provider - The fee is $77 (else leave blank)
If no previous ISP, please leave field blank.

Comments:

We will be treating the details you have completed on this form with confidentiality.