1 Contact Details2 Installation Details3 Billing Method4 Agreement & Completion Contact DetailsName* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Name Last Name Company NamePrimary Phone Number*Secondary Phone NumberEmail Address* Enter Email Confirm Email Date of Birth* Drivers License/Passport/Proof of Age*Billing Contact*Same as aboveDifferent emailNew Reachnet email account belowBilling Email Address* Enter Email Confirm Email Reachnet Email Address*As part of your service we provide a free email account. We will use a close match to the email address entered if your preference is unavailable. Only enter the portion of the email address before the @ symbol in the below field. &, $, #, @ and * characters are not accepted.@reachnetmain.wpengine.com Installation DetailsSite Installation Contact*Same as primary contactDifferent contactContact NameEnter the first and last name of the contact person for site installation. Installation Address*Please check your address information is correct as this will be used to install your service. Street Address City State Post Code Postal Address* Same as installation address Street Address City State Post Code Property CoordinatesIf your building is on a large property and you know your Latitude and Longitude please supply. Latitude must start with "-" (minus sign), be a maximum of 15 characters long, and only contain numerals and a decimal point. Longitude must be a maximum of 15 characters long, and only contain numerals and a decimal point.Property NameRoofing Material*Tin/Metal (e.g. Colourbond)Fibro cementTileOtherExternal Wall Material*Double brickSingle brick with claddingCladding (Timber, Compressed cement)Cladding (Asbestos, Fibro cement)OtherNumber of Storeys*SingleDoubleOtherPower Supply*Select AC power supply if your premises have access to AC mains power, or select DC power supply if your premises have a source of 8-24 volt DC power (e.g. solar)AC PowerDC PowerDo you have Sky Muster satellite equipment already installed?*YesNoProvider Name*Do you have an old IPSTAR Satellite dish (IPSTAR Branded) you would like removed from your roof/exterior?*If you have existing ISS satellite equipment installed (Gilat Skyedge IP modem), the technician can remove this at the time of installation for no extra charge.Yes, please remove my old IPSTAR branded equipment. I understand a removal fee of $135+GST will be charge to my accountNoBattery Backup Service Consent* I acknowledge and agree that: Customers are aware that NBN-based services, including broadband and voice services will not work during a power failure or if the power is switched off at, or disconnected from, the power point. This means customers will not be able to check emails, receive or make any calls. Customers should ensure they have an alternative service (e.g. a mobile phone) available to make emergency phone calls if their NBN-based service is not available. It is customers’ responsibility to discuss their requirements with their alarm provider and to ensure that any medical or security alarm equipment that they use will be compatible with their NBN service. In addition, customers are aware that alarm equipment will not operate in the event of a mains power disruption. Reachnet provides no assurance that such equipment is compatible with our service upon activation or any time after activation. Customers are aware that they have the option of choosing to install a battery backup for their NBN service. During a power failure, the battery backup will last for approximately five hours (including the battery emergency reserve). This battery backup will only supply power to the Network Termination Device in the event of a mains power outage. If their telephone requires mains power to function, then it will remain inoperable in a power outage, even if they have a battery backup unit. Customers are responsible for maintenance of the battery. Please refer to www.nbnco.com.au/battery for further details on operations and maintenance of the battery backup. If customers change their mind about the Battery Backup Service on the day of installation (e.g. from non battery backup to battery backup or vice versa), the installation will not proceed or not be completed on the day. The installation date will need to be rearranged.Battery Backup Service Option*Please note: Should you already have an NBN fibre service installed with another provider and are switching this service to Reachnet, please contact us directly to obtain pricing for a battery backup service to be installed. This will be at the customers expense and up-front payment maybe required.I would like to use data and telephone services without the Power Supply with Battery Backup and the Battery Backup Service.I am not satisfied about the inability to make calls or use data services during a power failure and would like the Power Supply with Battery Backup and the Battery Backup Service. I would like Battery Backup installed at the time of the installation and acknowledge the limitations of the Battery Backup service. Billing DetailsPreferred Payment Method*Direct DebitPay As You GoOn a monthly basis you can use one of the following options to pay your bill. All the required details to make your payment will be included on your monthly invoice. Please be aware Reachnet does not charge any credit card processing fees, however a late payment fee of $15 (inc GST) will be applied for overdue accounts. BPAY: Payments can be made directly via your financial institution. Credit Card: You can pay your bills monthly via the customer portal with a credit card of your choice. Alternatively, you can call and pay your bill via phone on 1300 464 778. Australia Post: Visit your local Australia Post office, call 13 18 16 or go to www.postbillpay.com.au. Australia Post accepts, cash, cheque or EFTPOSReachnet accepts both direct debit and credit card payments. Please be aware Reachnet does not charge any credit card processing fees. To ensure the security of your personal information we will send you a copy of the direct debit form via email with a summary of your order. We will get in touch during activation to ensure your service and billing information are correctly set up.Are you an existing Reachnet customer?*YesNoAccount NumberAccount number must be 6 characters in length.Who is your current ISP (Internet Service Provider)?How did you hear about Reachnet?*Please selectBrochure/LetterWebsiteGoogle/Other Search EngineSocial MediaOnline AdsFriends/FamilyRadioTVEventOtherPlease Specify*Referrer (Name or Customer #) AgreementYour plan summary Plan: [Insert plan name] Speed:[Insert plan speed] Term:[Insert plan term] month(s) Router:[Insert router choice] Total cost: $p/m + $router cost+ $set up fee $ minimum cost over month(s)View Critical Information Summary Download application formVerify your installation address Please take a moment to verify and confirm your information. If incorrect please click back through the form and update.Unit/Lot NumberStreet NumberEnd Street NumberApplicable if your property spans multiple street numbersStreet Name*Street TypeAccessAlleyAlleywayAmbleApproachArcadeArterialArteryAvenueBananBendBoardwalkBoulevardBraceBraeBreakBrowBypassBywayCausewayCentreChaseCircleCircuitCircusCloseConcourseCopseCornerCourtCourtyardCoveCrescentCrestCrossCul-de-sacCuttingDaleDipDriveDrivewayEdgeElbowEndEntranceEsplanadeExpresswayFairwayFollowFootwayFormationFreewayFrontageGapGardensGateGladeGlenGrangeGreenGroveHeightsHighroadHighwayHillInterchangeJunctionKeyLaneLanewayLineLinkLookoutLoopMallMeanderMewsMotorwayNookOutlookParadeParkwayPassPassagePathPathwayPiazzaPlacePlazaPocketPointPortPromenadeQuadrantQuaysRambleRestRetreatRidgeRiseRoadRdRotaryRouteRowRueServicewayShuntSpurSquareStreetSubwayTarnTerraceThoroughfareTollwayTopTorTrackTrailTurnUnderpassValeViaductViewVistaWalkWalkwayWayWharfWyndCity / Suburb*StateNew South WalesAustralian Captial TerritoryVictoriaTasmaniaSouth AustraliaWestern AustraliaNorthern TerritoryQueenslandPostcode*Terms and ConditionsBy submitting this form you acknowledge that:* You have agreed to a total monthly commitment for the contract term chosen, and you have read and the understand the Credit Check Terms and agree to all charges to be paid via your chosen payment method. You have read, understood and agree to the Terms and Conditions. You acknowledge and agree that you, or your site contact named above, will be present at all times during installation. You acknowledge and agree that you, or your site contact named above, is 18 years or older. Late cancellation or missed appointment of installation will incur a minimum surcharge of $150 + GST (the surcharge will vary depending on your location).