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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.aunz.net 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.isage.aunz.net for current plan rates |
| VOIP Package |
$10 Per Month |
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Voip access fees are charged per calender month. All current call rates are published on our website.
Voip services are for existing iSage broadband customer 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 iSage
Internet Terms & Conditions as published at www.isage.aunz.net, and that all
the details I have provided here are correct. I authorise iSage Internet to
perform any necessary credit checks to support this application under
Section 18(E)(1) (Privacy Act 1988). I am not under any contract with
another provider and I will inform iSage 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.
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| Signature: |
 | Date: |
| Print Name: |
| Title/Position: |
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