Residential Application

Services Application Form

Agreement with Star Telecom [ABN: 37 162 881 601]

Section 1: Customer Details

Title

First Name

Surname

Drive License (Individuals)

Date of Birth

Section 2: Service Address (PO Box not permitted)

Unit/Suite

Address

Suburb

State

Post Code

Contact Name

Phone

Mobile

Section 3: Billing Address (If different from above)

Street / PO Box Address

Suburb

State

Postcode

Section 4: Plan Selection

Select the Service

Service Type

Current Service Provider

Account Number

Service Number

Select your Plan

Professional Installation Required (optional) - $165 fee

Service Type

Current Service Provider

Account Number

Service Number

Select your Plan

Professional Installation Required (optional) - $165 fee

Service Type

Current Service Provider

Account Number

Service Number

Select your Plan

Professional Installation Required (optional) - $165 fee

Service Type

Current Service Provider

Account Number

Service Number

Select your Plan

Professional Installation Required (optional) - $165 fee

Service Type

Current Service Provider

Account Number

Service Number

Date of Birth (for porting pre-paid number)

Select your Plan

Professional Installation Required (optional) - $165 fee

Mobile ServiceWe require following details if we are to port your existing number to Star Telecom, any you agree to out porting terms and conditions

Service Number

Current Service Provider

Account Number

Date of Birth (for porting pre-paid number)

Mobile Plan 1

Monthly Fee

Mobile Plan 2

Monthly Fee

Mobile Plan 3

Monthly Fee

Section 5: Direct Debit Details (Recommended) Non-direct debit customer will be charged a $55 activation fee and a admin fee of $3.30 every month

Debit Options

5.1 Direct Debit to Bank Account

Name of Account Holder

Financial Institution

Branch

BSB

Account No

5.2 Direct Debit to Credit Card (For Amex 3.7% surcharge apply)

Card Type

Credit Card Number

Expiry Date

Card Holder's Name

Section 6: Agreements

I have read and understand the direct debit terms and conditions and authorise Telecommunication Payment Services to debit the account described below under the Direct Debit System. I confirm I am the holder of that account.

I have read, understood and accept the terms & conditions and the terms of Star Telecom’s SFOA for all Services listed on this application and it’s attachments including the term of agreement(s).