Albury Local Internet Online Registration Form

Contact Name:

Date of Birth:

Driver's Licence No:

Company Name
(if applicable):

ACN or ABN:

Postal Address:

City:

State:

Post Code:

Please complete the next section only if you have a separate (different) Billing address.

Billing Address:

City:

State:

Post Code:

Telephone (AH):		Fax (AH):
Telephone (BH):		Fax (BH):

Joining Fee:

$50 (non-refundable, once-off, paid on application)

Access Plans: - Standard (Volume) is default:

Standard (Volume)	$2.40 per hour plus 35c per Mb. No minimum monthly or yearly charges; pay only for the time and data you use.
Plan-30	$27.50 per calendar month plan fee. Includes 30 hours and 75 Mb. Excess time or data charged at Standard plan rates (see above).
One Ton	$55 per calendar month plan fee. Includes 100 hours and 150 Mb. Excess time or data charged at Standard plan rates (see above).
FlexiChat	$1.09/hour for calls over 30mins long and under 0.5Mb volume per hour. $5.50 per month plan fee.
Commercial	$110 per calendar month plan fee. Includes 220 hours and 250 Mb. Excess time or data charged at Standard plan rates (see above). $220 plan setup fee.
Enterprise	No charge (*) for calls at any time. 1000Mb volume cap; $220/month plan fee. $440 plan setup fee.

(*) NOTE: Time or volume used in excess of plan stated conditions will be charged at Standard (Volume) Plan rate.

Additional email address or alias:
Additional email addresses are limited to nine (9) characters.
If you require an address of more than 9 characters, you should request an alias.
NB: The basic account includes one (1) email address.

	I do not require additional email address(es).
	I do require an additional I would like as my extra email/alias. (Extra address/alias fee: $1.10 per month.

Please select your payment method:
Cheque
Cash
Bankcard
Mastercard
Visa
American Express
Diners Club
Consolidate (specify existing account):

Please note: Credit terms 14 days maximum and only available to approved business accounts,
or credit card accounts; pre-payment for access charges is required for cash subscribers.
Accounts can be converted from cash to credit card at any time for no extra charge (minors may,
with the cardholders permission, use a parent or relatives' card).

Please use my credit card for

Card Number:

Expiry:

Name embossed on card:

Computer Operating System:

Preferred username:

Note: Selecting your own username/email address is optional.
Maximum nine (9) characters. MUST be obviously derived from either your name or
your registered business or company name. EG: "Fred Citizen" may use "fcitizen"
or "fredc"; or a business registered as "Widgets Pty Ltd" may use "widgets".

Mail Domain:

Optional - albury.net.au is standard.

Please enter any additional supporting information, or special instructions.

You obviously have access to the Internet already. We can send you the username, password
and configuration details via e-mail first so you can be on-line more quickly (without
having to wait for the post!). If you would like us to do this, fill in your e-mail here:
Optional

Before completing this application you must read and agree to our Terms and Conditions.

I have read the Terms and Conditions and agree to them.

(Fields marked with a are mandatory, all prices include GST.)