Wireless Broadband and Phone Application Form Please complete this form and fax to

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1 Wireless Broadband and Phone Application Form Please complete this form and fax to No one likes paperwork! But we are sure you don t mind ticking a few boxes so you can get exactly what you want from our many flexible options. Below is a summary of the sections you need to fill in so we can get you up and running. Step 1 Complete your contact details Choose one of the two special Broadband and ClearTalk bundles or custom choose your own ClearTalk and Broadband Plan combination. Step 2 If you have chosen a Clear Networks special bundle, tick your choice of plan, your preferred contract option and got to step 3b. OR Step 3 If you want to choose your own Broadband plan, just tick your preferred broadband plan and contract option. AND/OR Step 4 If you want to add ClearTalk to your broadband just tick your preferred ClearTalk plan. Step 5 Select your preferred inbound phone number Step 6 Choose your ClearTalk hardware Step 7 Set up your clearmail addresses Step 8 Let us know which operating system you are using Step 9 Complete your payment details Step 10 Read the terms and conditions and sign your application form. PLEASE COMPLETE ALL FIELDS AND RETURN THIS FORM TO Fax Apply Online Mail Clear Networks Provisioning Reply Paid 333 Blackburn VIC 3130 Call Us For more information contact Clear Networks Phone: Monday to Friday: 8am 8pm Clear Networks ADSL Application Form CN ADSL 0409 Page 1

2 Clear Networks Contact Information Clear Networks Pty Ltd ABN: PO Box 333, Blackburn Melbourne VIC 3130 REFER A FRIEND INFORMATION Support: Sales: sales@clearnetworks.com.au Web: NOTE: For you and your friend to benefit please supply us with the following information. Full Name of Referrer Referrer s Clear Customer Number NOTE: This section for Clear Networks Dealers only. Dealer Name: Dealer Code: Information All Clear Networks customers are billed monthly automatically and are to provide credit card or direct debit details Incomplete application forms may result in delayed installation For any queries please contact Clear Networks Customer Care on or sales@clearnetworks.com.au 1 Contact and Installation Details First Name Last Name Business Name (if applicable) ABN Number Address Date Of Birth dd/mm/yyyy / / Suburb / Town State Post Code Day Time Phone Number Mobile Phone Number After Hours Phone Number Fax Number Correspondence Address NOTE: Only used until your account is activated. I wish to use this for ongoing correspondence I wish to use my new ClearMail account for correspondence Installation Address if different from above Suburb / Town State Postcode 2 Username and Password Please specify your desired username(s) and password(s) below USER 1 IS MANDATORY: This address is the address Clear Networks directs network updates & account information to, Accounts 2 to 5 are Optional, Min of 6 alphanumeric characters. No special characters. Get extra s for $1.00/month/ . Get PREMIUM Spam/Virus Filtering for $2.20/month/ . Username clearmail.com.au Username clearmail.com.au Username clearmail.com.au Username clearmail.com.au Username clearmail.com.au Password 1: (min 6 characters) Password 2: (min 6 characters) Password 3: (min 6 characters) Password 4: (min 6 characters) Password 5: (min 6 characters) Note: Your preferred address may not be available. In this case we will ask you to specify alternatives. This username will become your primary ClearMail address and webspace address. CN WIRELESS 0409 Page 2

3 2a Select A Bundle Plan Option (Phone and Internet) 3b Tailor Your Plan Features Select one of these two great bundles and your contract type then go to Step 3b. Or go straight to step 3a to choose your own combination of phone and broadband plans. A) Please select a plan Speed Plan Monthly Data Allowance TOTAL/PEAK/OFF PEAK 512k/128k ClearTalk Broadband Plus 1M/256k ClearTalk Broadband Plus B) Choose contract period Cap 12 months $199 installation Monthly Fee Calls included 4GB / 2GB / 2GB $44.95 $15 10GB / 5GB / 5GB $79.95 Unlimited 24 months $99 installation (Normally $350) 3a Plan choice Choose either Capped or Volume 36 months $0 installation (Normally $175) Select your choice of plan, volume or capped, then your usage options. Please complete the Family Friendly section to SUPERCHARGE the features of your broadband plan. A) Please tick (select one only) Capped (shaped to 64k/64k after 100% plan usage) Volume (plan not shaped: but $0.09/MB applies after 100% plan usage is reached. Our Usage Meter will notify you when you are close to your limit.) B) Please tick (select one only) Broadband Standalone Broadband and ClearTalk Bundled (VoIP / Broadband Phone) (see next page for ClearTalk plan options and combine Broadband and ClearTalk monthly fees to determine your monthly total) C) Select your plan ($5 off your bill if a ClearTalk Phone Plan is also selected) Unlike any other provider, we offer you a range of FLEXIBLE OPTIONS that tailor your plan to your needs. Select as many of the following options as you like that suit you, your family or business. Family Friendly Pack - $7.95/month includes: NORMALLY $9.95/month this is a special introductory price! $250/year of VALUE for ONLY $95.40 over a 12 month period!! 50% More Data During School Holidays in your state! Family Friendly Content Filtering - protect your family from unwanted content Suggested Family Links A Blogging Tool (coming soon) A Gallery Tool (coming soon) Increased Web Space to 100MB NOTE: Minimum commitment is 3 months ($23.85) ADVANCED SPAM / VIRUS FILTERING Optional Highly Recommended Note: Basic spam & virus filtering already included in your plan. Advanced Spam/Virus filtering $2.20 applied to EACH address per month Scans all incoming s to your ClearMail account for viruses and spam to help protect your computer. Access to Quarantine and advanced management of your . NOTE: Minimum commitment is 12 months EXTRA DATA per MONTH (select one option below) $15/month 1GB (500MB peak / 500MB off peak) $22/month 2GB (1GB peak / 1GB off peak) Select > First Month OR Ongoing (You can cancel this at any time in the future) EXTRA WEB SPACE (select one option below) NOTE: comes with Blogging and Gallery tools $5/month 100MB $10/month 250MB NOTE: Minimum commitment is 12 months Speed Plan Monthly Data Allowance Monthly Bundled Fee Monthly Standalone Fee TOTAL/PEAK/OFF PEAK 512k/128k Budget 1GB / 500MB / 500MB $14.95 $ k/128k Standard 2GB / 1GB / 1GB $24.95 $29.95 Standard2 4GB / 2GB / 2GB $34.95 $39.95 Standard 10 20GB / 10GB / 10GB $64.95 $ M/256k Pro 4GB / 2GB / 2GB $39.95 $44.95 Pro8 16GB / 8GB / 8GB $54.95 $59.95 Pro20 40GB / 20GB / 20GB $74.95 $ M/512k Power 8GB / 4GB / 4GB $49.95 $54.95 Power10 20GB / 10GB / 10GB $74.95 $79.95 Power20 40GB / 20GB / 20GB $90.95 $95.95 NOTES: Capped plans are shaped to 64k/64k when data allowance is reached. Each timeslot is capped separately. Included with your broadband - Free 10MB web space, 5 addresses, Free BASIC Spam / Virus filtering, FREE public IP address. C) CHOOSE CONTRACT PERIOD 12 months $199 installation 24 months $99 installation (Normally $350) 36 months $0 installation (Normally $175) CN WIRELESS 0409 Page 3

4 3c ClearTalk Phone Information If you to sign up for Clear Talk, please fill out the following section, if not skip to section 5. ClearTalk is telephone service delivered over broadband connection it DOES NOT use your phone line. I wish to keep my existing phone service and use ClearTalk as a separate service I wish to churn my phone number and service to ClearTalk Please fill in the details below if you have selected this option. Note: This option incurs a $40 and your existing phone service will be disconnected on transferring. Your existing provider will send you a final bill. Existing Phone Number ( ) Name on bill of existing phone service provider: Account no. of existing phone service provider: Select time for transfer: AM PM Select ONE of the following plans: CLEARTALK BUDGET CLEARTALK STANDARD CLEARTALK CAP CLEARTALK WORLD Monthly Fee: $6.95 Monthly Fee: $19.95 Monthly Fee: $39.95 Monthly Fee: $49.95 DID Number/month: $6.00 DID Number/month: $6.00 DID Number/month: Included DID Number/month: Included Tick to add Tick to add Included Calls: $0.00 Included Calls: $15 credit Included Calls: Unlimited Included Calls: Unlimited Local Call Rate: 15 cents Local Call Rate: 13 cents Local Call Rate: 0 cents Local Call Rate: 0 cents STD Call Rate: 15 cents STD Call Rate: 13 cents STD Call Rate: 0 cents STD Call Rate: 0 cents International Calls: from 3.5 cents per min International Calls: from 3.5 cents per min International Calls: from 3.5 cents per min International Calls: from 20 cents untimed Mobile rate: $0.30 per min Mobile rate: $0.27 per min Mobile rate: $0.27 per min Mobile rate: $0.27 per min 3d Choose your ClearTalk Hardware For ClearTalk To make ClearTalk calls you can use your own phone with an adaptor (ATA) or plug in a new ClearTalk ready phone - options available below. My Choice Product Router RRP Special Contract / Bundle Price* *24/36 month contract N/A I have my own ATA or IP Phone and/or do not require equipment N/A FREE FREE Linksys ATA (Model No. PAP2NA) Use your existing phone to make calls using our ATA. Router $154 $29.95 (FREE with Bundle plans) Linksys ATA (Model No. SPA3102-NA) Use your existing phone to make calls using our ATA without the need to have a router. It also enables you to receive faxes and is compatible with all common telephone features. GrandStream Phone (Model No. BT200) This phone has excellent audio quality and rich features. It's an affordable, easy to use phone for the home or office. No Router Router may be $218 $59.95 $139 $29.95 (FREE with Bundle plans) D-Link Cordless DECT Phone (Model No. DPH-C160S) This cordless phone is ready to work on ClearTalk. Plug the base into your broadband connection and place the phone wherever you wish. Router $269 $ Þ Plus $15 postage and handling. Equipment s will be added to your first month's bill - if you require equipment. 3e ClearTalk Agreement **must tick if you ve selected ClearTalk** I agree that I have sighted the ClearTalk Terms and Conditions either by visiting or have received a hard copy of the conditions. 4 Computer Information Win Vista Win XP Win 2000 Win ME Win 98 NT4 Mac OSX Mac OS8/9 Note: Our system supports Mac OSX, Win XP and Linux. If you do not have these you may need additional hardware or software. It is also recommended you have a firewall. Call our Customer Care Team on if you need to buy one. CN WIRELESS 0409 Page 4

5 5 Additional Question How did you hear about Clear Networks? DBCDE Web Site Google Ad Mailbox Delivery Direct phone call The Land Friend/Clear Customer Broadband Service Locator Radio TV Clear Rep Other Search Engine Clear Dealer Google Search Other 6 Payment Details Please select either Credit Card or Direct Debit for your payment method CREDIT CARD OR DIRECT DEBIT Visa MasterCard Name On Card BSB Number Card Number Account Number Expiry (MM / YY) Account Name I agree that Clear Networks Pty Ltd can deduct money from that account, on the day my invoice is due as long as I have a Clear account, or; I agree until I withdraw their permission for the direct debit and make another payment arrangement. I am able to operate this nominated account as a sole signatory. I authorise Clear to contact my financial institution to verify my bank account details. I authorise my financial institution to release information allowing Clear to verify my bank account details. I understand that by proceeding now I will be deemed to have signed a direct debit authority. Signature Date (DD / MM / YYYY) / / 7 I agree to I attest to, and understand that: The personal information I have provided is true and accurate; and I am at least 18 years of age Please tick: I agree with and understand the Terms and Conditions in applying for broadband services with Clear Networks. I agree that I have sighted the contract and the Acceptable Use Policy by visiting or have received a hard copy of the conditions. I therefore accept the contract Terms and Conditions and the Acceptable Use Policy. Print Name: Signed: Date: (dd/mm/yyyy) CN WIRELESS 0409 Page 5