Rural Internet Order Please complete this order form and our technicians will be in contact to arrange your install. This form does not guarantee that our service is available in your area, 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. Critical Information Summary Standard Form of Agreement Customer Relationship Agreement 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 *---I would like to discussBasic $59.00 pm (400GB data, max. 20MBps down, 5MBps up)Medium $79.00 pm (Unlimited data, max. 50Mbps down, 20MBps up)Ultimate $99.00 pm (Unlimited data, max. 70MBps down, 20Mbps up)__________________________________Business 1 $99.00 pm (Unlimited data, max. 50Mbps down, 20MBps up, same day SLA)Business 2 $139.00 pm (Unlimited data, max. 50Mbps down, 20MBps up, same day SLA + 4G backup)Customised Business Plan Modem *---I am unsure what is suitable and would like to discuss a new modem at the installI need standard Wi-Fi (normal use, average house size) $149I need strong Wi-Fi and would like a custom quoteI would like to check if I can use the modem from my previous provider (Please see note below) NOTE:* I understand that a $50.00 service fee may apply where my existing equipment requires more than basic setup.* While the technician will make reasonable efforts to use existing equipment, CWNet cannot guarantee compatibility with their network due to possible restrictions from your previous provider. * I understand that CWNet cannot provide a warranty on equipment they did not supply. * I understand that if my existing equipment is not compatible, I may purchase suitable equipment from CWNet or another retailer. Wi-Fi Setup *---I am happy to set up my own Wi-FiI would like to add Wi-Fi setup to my installation ($99 per hour) Do you currently have an active internet connection *---Yes - I currently have a plan with another providerNo - I do not have internet Do you have a home phone/land line that you would like to keep? *---Yes - I would like to transfer it over (we will be in touch to discuss)No - I do not have a number / do not want to keep it / would like to keep it but happy with our current provider ____________________________________________ Contract 1 - I will read and understand the terms and conditions set out in the "Customer Relationship Agreement" and "Standard Form of Agreement" as linked above and via https://www.cwnet.com.au/tc/ *YesNo Contract 2 - I agree to the above nominated plan for the minimum term of one (1) month and understand that the plan fee and any non-standard installation costs are to be charged on the day of the install *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 ____________________________________________ Word of mouth (please give their name so that we can thank them!)Word of mouth (please give their name so that we can thank them!) *Social Media (FB/Insta)Print advertising (Flyer)Sign around townRadioWord of mouth Referral name Additional comments or questions Submit Standard installation does NOT include a Wireless router and or modem No cancelation fees* Service not guaranteed at all addresses, please submit and enquiry to find out if your address is available Real Estate permission template Customer Relationship Agreement Standard Form of Agreement Critical Information Summary
