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1. Customer Details
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| Full Name: |
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Account Number: |
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2. Payment Method |
| Monthly payment by: |
 VISA |
MasterCard |
| Card Number: |
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Expiry Date: |
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| Cardholder Signature: |
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Date: |
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Please
note your signature constitutes sufficient authority for iSage Internet to or its nominee to initiate a transaction every
month with the above Credit Card account for payment of any monies
outstanding and due by you. |
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3. VoIP Service Details
Refer www.aunix.com.au for current plan rates |
| VOIP Package |
$10 Per Month |
| |
Voip access fees are charged per calender month. All current call rates are published on our website.
Voip services are for existing AuNix broadband customers only. Credit card customers only. |
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4. Customer Agreement |
By
signing this form I am stating that I have read and agreed to the AuNix
Internet Terms & Conditions as published at www.aunix.com.au, and
that all the details I have provided here are correct. I authorise
AuNix Internet to perform any necessary credit checks to support this
application. I am not under any contract with another provider and I
will inform AuNix Internet in writing of any changes to my details. I
confirm I am 18 years of age or older and am authorised to enter into
this agreement. |
| Signature: |
 | Date: |
| Print Name: |
| Title/Position: |
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