Customer Information

Service Application for Neptune, ABN 363 905 216 42, P.O. Box 398, Mt Waverly, VIC 3149.
Call 1300 669 474 | Fax 1300 303 857 | Email admin@neptunecom.com.au | Go to www.neptunecom.com.au

1 Customer

2 Phones

3 Mobiles

4 Internet

Business Customers

Legal Entity

Trading As

ACN/ARBN

ABN

Years Trading

Contact Title

Name

Position

Address 1

Address 2

City/Suburb

State

Postcode

Billing Address (if different from above)

Address 1

Address 2

City/Suburb

State

Postcode

Telephone

Mobile

Fax

Email

Desired Online Password

Home Customers

Title

Name

Drivers License / Passport No

Date of Birth

Address

Address 2

City/Suburb

State

Postcode

Telephone

Mobile

Fax

Email

Desired Online Password

 1 Customer

2 Phones

3 Mobiles

4 Internet

Services

Churn

New

Service Number

Service Type

Account Number

Plan

Term

Long Dist

Full
Serv

months

months

ISDN Number Range

From

to  

ISDN

DAL

Telephone Company from

Telephone Company to

Neptune

Inbound Services

New

Port

Service Number

Answer Point

Overflow

Complex Routing

SmartNumber
ROU PIN (if app)

Setup Fee

Monthly Fee

$

$

$

$

Wholesale Carrier Name

Wholesale Carrier Account No

1 Customer

2 Phones

3 Mobiles

4 Internet

Services

Network choice:

Telstra 2G

Vodafone 3G

New

Port

Mobile Number

Current Service Providers

Plan Name

Term

Account Number (post paid)

Date of Birth (pre-paid)

months

$

months

$

Handsets

Mobile Number

Handset Make

Handset Model

Outright Price

Contract Term

Ext Warranty

Insurance

Monthly Fee

$

months

$

1 Customer

2 Phones

3 Mobiles

4 Internet

Broadband (DSL)

New Service

Telephone number (inc area code)

Transfer Existing Service

Telephone number (inc area code)

Existing Provider Name

Address to Connect Service to if different from Section 1

Address 1

Plan Speed

City/Suburb

State

Postcode

Wireless Broadband (iBurst)

New

BYO

UTID if BYO

Modem Type

Plan

Username

Password

Term

Monthly Fee

months

$

months

$

Dialup

Speed (kbps)

Included Data

Username

Password

Monthly Fee

56

Unlimited

$

Maximum session time of 4 hours applies. Idle timeout after 30 minutes. Data calls charged at the rates indicated by your service provider.

Email Addresses

You may have up to 6 email addresses on your service. Please specify the email address/es you would like

Email Address

@neptunecom.com.au

Password

Email Address

@neptunecom.com.au

Password

@neptunecom.com.au

@neptunecom.com.au

@neptunecom.com.au 

@neptunecom.com.au 

Domain Registration

New

Registration Fee

$

Please choose up to 4 in order of preference for us to register for you:

1^st Choice

www.   

2^nd Choice

www.      

3^rd Choice

www. 

4^th Choice

www.  

Transfer

Domain Name

Registry Key

Transfer Fee

$

Web & Mail Hosting

SQL Y N

Domain Name

Registry Key

Monthly Fee

$

Please list the email accounts you need us to host for you. If further accounts/aliases required, please provide separately.

Email Address

Password

Email Address

Password

VoIP

Services:

Plan

Indial

Prefix

Voicemail

PIN

Email Address for Voicemail

Monthly Fee

$  

$  

$  

Hardware:

VoIP Hardware

Make

Model

Fee

Quantity

Total

IP Handset

$  

$

ATA

$

$

Modem

$  

$