BATHURST CBD/ SUBURBS Internet Order Please complete this order form and our accounts team will be in contact to arrange your install. This form does not guarantee that our service is available at your address, this will be confirmed by our technician prior to your install. If you wish to change the details of your selected plan please call to speak to our accounts team prior to your installation date. Before you complete the order please read the Terms and Conditions and the Critical Information Summary below. Terms & Conditions Critical Information Summary Real estate permission template First Name * Last Name * Business Name DOB * Service Address * Suburb * Postcode * Preferred Contact Number * Alternate Phone Number Email Address * Confirm Email address * ______________________________________ Would you like to add another person who can access your account? Authorised Account Contact Authorised contact phone number Authorised contact DOB Authority levelLimited - enquire / discuss onlyFull authority to act on my behalf ______________________________________ Selected Plan *---VALUE: $49.95pm (unlimited data, 50mbps down / 20mbps up)SPEED+ : $69.95pm (unlimited data, 100mbps down / 20mbps up)BUSINESS 1: (unlimited data, 100mbps down / 20mbps up, plus 4G backup)DISCUSS A CUSTOM PLAN: Thank you for your application, our team will be in touch to discuss your needs Wireless equipment - A standard installation does NOT include a wireless router or modem. *---I would like to check if I can use the modem from my previous provider (Please see note below)I would like to discuss a new modem at the install NOTE* I understand that if I choose to use my existing wireless equipment, CWNet cannot guarantee its compatibility with their network due to potential restrictions from my previous provider. While CWNet will make all reasonable efforts to utilise my existing equipment, they do not warrant any hardware that they do not supply. I understand that if my existing wireless equipment cannot be used, I have the option to purchase my own from an outside retailer or directly from CWNet during installation. The agreed amount will be added to my monthly bill or otherwise arranged with the technician. ______________________________________ Contract 1 - I will read and understand the terms and conditions set out in the current version as linked above via https://www.cwnet.com.au/tc/ *YesNo Contract 2 - I agree to the above nominated plan for the minimum term of 1 month and understand that this is to be paid within 5 days of my service being activated. *YesNo Contract 3 - I understand I will require to provide ID and Signatures on the day of the installation *YesNo Contract 4 - I am the owner of the property, or have permission from the owner of the property, for a wall plate to be installed on internal wall of the building, and a mount and small dish to be installed on the roof of the building *YesNo Contract 5 - I agree to CWNet contacting me on the email and phone number provided above for the purposes of implementing and maintaining my account, general announcements and occasional promotions *YesNo ______________________________________ Where did you hear about us? *Social Media (FB/Insta)Print advertising (Flyer)Sign around townWord of mouth Additional comments or questions Submit
