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
TBA
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
Modem Router
One port router
$80 rrp
Wireless router
$160
Voice enabled router
$180
4 port router
$110
Wireless router fire walled
$210
Voice enabled wireless router
$290
Pay your line provisioning and router in 6 monthly instalments
PLEASE NOTE
1. WebShield will provide preconfigured modem routers as part of the setup process
2. WebShield charges a a Student levy of $2 per student per year.
3. The Telstra charge for termination of a broadband connection before 6 months is $87
4. 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.
ALL CONTENT © WEBSHIELD 2005
