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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
*
Write None for no home phone
Mobile Number
*
Does your mobile phone work at home?
*
Yes - Telstra
Yes - Optus
No
Are you interested in our Unlimited home phone?
*
Yes
No, Yes i know its only $34.95 Unlimited in Australia
Email Address
*
Email
Confirm Email
Residential plan details
*
Ultimate - $149.00 - Unlimited Monthly
Family - $119.00 - 750Gb Monthly
Medium - $99.00 - 500Gb Monthly
Basic Plus - $69.00 - 250Gb Monthly
Light - $39.00 - 150Gb Monthly
Contract Term
*
12 Months - $440.00 Payable on installation
24 Months - $330.00 Payable on installation
No Contract - $660.00 Payable on installation
If for any reason we cant install you, you will not be charged.
Would you like a Backup Battery installed?
*
Yes, please pick option below
No, thanks
700VA $199.00
1000VA $229.00
1500VA $269.00
2200VA $368.00
3000VA $999.00
5000VA $2599.00
*Modem and mobile devices. 700VA 20 Mins approx. 1000VA 30 Mins approx. 1500VA 50 Mins approx. 2200VA 70 Mins approx.
Would you like a static IP?
*
YES - $10.00 Monthly
No thanks
Third Choice
Upgraded Wi-Fi, Internal and external
*
No Thanks.
Ceiling Access Point, 120 Meter range, $409.00 at installation
Please onsite quote full WI-FI.
Full farm Wi-Fi quote.
Did a friend refer you ?
Please advise their full name and phone number.
Additional Notes
Do you require a RemoteISP email address?
*
Yes
No
New Wi-Fi (ssid) Name
*
Property Name, Last name etc etc. If your unsure write at installation.
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/
*
Yes
No
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
*
Yes
No
Contract 3, I understand i will require to provide ID and Signatures on the day of the installation
*
Yes
No
We use and App to capture ID's, Signatures and Photos of the Installation for Quality purposes.
Signature
Clear Signature
Name
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