Greenbank Net Permanent Connection
Telephone: (07) 3876 9044 Facsimile: (07) 3876 9033 P.O.Box 2079 Graceville 4075
1. Client Details
|
Name |
|||
|
Address |
P/C |
||
|
Home Phone Number |
Work Phone Number |
||
|
Mobile Number |
Work Fax Number |
||
|
Date of Birth |
Drivers Licence No: |
||
2. Where did you hear about Greenbank.net?
|
Internet |
Advertising |
Word of Mouth |
Direct Mail |
Seminar |
Other_________________ |
3. Please tick operating system
|
Windows 95 |
Windows NT |
Windows 3.X |
Macintosh 7.X or 8.X |
Other |
4. Connection Details
|
Login Name (1st Choice) |
|
Login name must be between 3 and 8 Characters. E.g. John Smith might choose jsmith@greenbank.net.au or johns@greenbank.net.au Lower case can only be used. |
|
Login Name (2nd Choice) |
|
Please indicate a 2nd choice for your login name in case your first choice is not available. Lower case can only be used. |
|
Password |
|
Passwords must be between 6-8 characters and can include numbers E.g. star123. Lower case can only be used. |
5. Additional Mail Boxes
|
User Name |
Email Address |
Password |
|
|
Additional Mailboxes can be purchased at $10.00 per month. Please advise on a separate piece of paper user names, email addresses and passwords if you require additional mailboxes or Web space.
6. Payment Details
|
|
Cheque |
Bank Card |
Visa Card |
Master Card |
|
Name on Card |
|
||
|
Card Number |
|
||
|
Expiry Date |
|
Total |
$ $149 + $200 Setup = $ |
Agreement: I have read, understood, and hereby agree to Greenbank.net's "Terms and Conditions" as amended.
Signature: ______________________________________ Date: ________________
|
Permanent connection |
Condition |
|
$149 Per Month for 500 Meg downloads Per Month |
Excess data will be charged at $0.25 Per Meg |
Accounts will not be created until payment in advance in full is received. Subsequently, credit cards will be debited in advance until terminated by notification in writing. Submission to Greenbank.net of this form constitutes a binding contract subject to Greenbank.net’s "Terms and Conditions" as amended from time to time. Current Terms and conditions can be found on Greenbank.net’s web site at – http://www.greenbank.net.au/terms.html
