99Unlimited - RemoteISP

Boxers Creek and Run-o-Waters and Special Offers.

Name *

First

Last

Business Name

If applicable

ABN

If applicable

Date of Birth *

Just to match your identification that needs to be viewed on the day of installation.

Street Address *

Suburb *

State *

Postcode *

Home Phone Number

Mobile Number *

No Spaces.

Does your mobile phone work at home? *

Are you interested in our Unlimited home phone? *

Current provider and account number. *

We will email you as we require your current bill.

Email Address *

Email

Confirm Email

Residential plan details *

Contract Term, 2 Year Warrenty. *

If for any reason we cant install you, you will not be charged.

Free Reconnect? *

Yes, If you dont have equipment onsite your application will be delayed.
No, Please choose no contract.

30 Days Cancellation Notice Required

Upgraded Wi-Fi, Internal and external *

Standard Wi-Fi does approximately 40 Meter Radius.

Did a friend refer you ?

Please advise their full name and phone number.

Additional Notes

New Wi-Fi Name (ssid) *

Property Name, Last name etc etc. At Install if unsure.

Password for your Wi-Fi *

8 characters min. 12 characters max.

Contract 1, I will read and understand the terms and conditions on www.remoteisp.com.au web site set out in the current version at https://remoteisp.com.au/tc/ *

Contract 2, I agree to the above nominated contract term and installation payment method and understand its paid in advanced on the day of the install *

Contract 3, I understand i will require to provide ID and Signatures on the day of the installation *

We use and App to capture ID's, Signatures and Photos of the Installation for Quality purposes.

Signature

Boxers Creek and Run-o-Waters and Special Offers.

Bathurst Will Become CWNET.com.au 1st Feb 2023