NGV NBN Application Form

Date of application (required)
Date service required (required)

Billing & contact details

First Applicant
First Name (required)

Surname (required)


D.O.B (required)


Are you? MaleFemale
Second Applicant
First Name


Surname


D.O.B


Are you? MaleFemale

Install Address (required)
Mailing Address (required)
Mobile Number (required)
E-Mail

*Please see attached terms and conditions or visit our website at www.ngvwifi.com.au

Security

To ensure your privacy you may be asked to identify yourself with personal information.
This may include any such information you provide on this application agreement, however for added security, please choose a question that only you will know the answer to: e.g My place of birth.

Question
Answer

NBN

Unlimited Data Plans

12/1Mbps Down/Up - $60 p/m25/10Mbps Down/Up - $65 p/m50/20Mbps Down/Up - $70 p/m**100/40Mbps Down/Up - $90 p/m

Do you require a wireless AP/modem/router?

Yes - $125No

Please specify make and model of AP/modem/router you will be using

Make

Model

Please be aware your own modem/router may not be compatible with your new service and cannot be supported by NGV, please call if you are unsure.

Internet password? (This is required to allow you to access information regarding your data, including usage). Must be minimum 8 characters long

WiFi Password? This is only required if you have requested a new modem/router. Must be minimum 8 characters long. (This password allows you to connect your devices wirelessly to your NGV internet service)

New wireless AP/modem/router: $125

*For additional costs and information please see the terms and conditions.

** Only available at applicable locations.

If a technician is required to visit your premise to complete your internet connection there is a one off charge of $100.

Address Verification

We require 1 of the below forms of Proof of Occupancy to support your application. Please tick which document you are providing:




Please attach complimenting document here:


Direct debit

Direct Debit payment method is mandatory in order to receive services from Next Generation Voice Pty Ltd.

By providing my credit card details, I hereby agree and give Next Generation Voice Pty Ltd permission to charge and debit my credit card for the duration I have services with Next Generation Voice Pty Ltd.

Debits will occur on a monthly basis on the invoice due date. I understand I am able to cancel this direct debit at any time by providing notification in writing to Next Generation Voice Pty Ltd.

If my contract states it is mandatory I pay my account by direct debit, I understand that by cancelling my direct debit I am also cancelling my services. No refund is applicable for cancellation of services that occurs prior to the billing date.

Please complete all the fields below..

Card Number


CVC
Expiry - Month


Expiry - Year
Signature

Invoice delivery

Billing email address


Signature and acceptance

I request the supply of the above services on the terms & conditions and customer agreement provided.
I warrant that all information in this application is true and correct. If I am an individual applicant I consent under the Privacy Act 1988 (Cth), to the access, use and disclosure of information by NGV in any circumstances not prohibited by the Act. I warrant that I am NGV’s customer in respect of the services.
If the Customer is a company, signatory hereby warrants that he/she is duly authorised to sign this application on behalf of the Company.

Representative Full Name
Date

To return your completed application you can email it to us at: provisioning@ngv.com.au or mail it to us at: 1/37 Expansion St, Molendinar, QLD 4214 or alternatively return the completed form to your community manager and they will pass it on to us.

Signature

General terms and conditions

  1. NGV provides support services for Internet related issues between the hours of 8.30am and 4pm, Monday to Friday only.
    This excludes public holidays. The contact number for support is 1800 007 648. After hours support available for
    emergencies only.
  2. Limitations of the service: NGV will use reasonable commercial endeavours to provide a continuous service. However,
    makes no guarantees that access will be available at all times and, to the extent permitted by law, will not be liable for any
    losses whatsoever that may be incurred as a result of the unavailability of the Service. You acknowledge that there may be a
    reduction in availability during periods of maintenance and enhancement of the Service The installation of the services may
    cause temporary interruption to current Internet provision or telephony services.
  3. The NGV service can be connected to a Switch or Wireless Router to service multiple PC’s.
  4. NGV is not responsible for malicious attacks by Virus, Trojans & Worms which may cause the user’s computer to be
    damaged or require repair. All PC protection software is the sole responsibility of the end user.
  5. A connection fee of $300.00 may be applicable if your site is a Greenfield site.
  6. Service connection fee is determined by the NBN and is in addition to any fees contained in this agreement.
  7. If a tech install (site visit) is required, an additional $100 charge will apply, please contact our office if you are unsure if
    you will require a visit.
  8. $150.00 incorrect callout fee is payable by the customer when a fault is lodged which results in a technician visit to the premises, and the fault is not found to be with the network.
  9. The minimum service contract is 1 month, there is no lock-in period and you are free to disconnect your service after the
    first month.
  10. New connections will be pro-rata from the date that the service is connected.
  11. All prices stated on this application form are inclusive of GST.
  12. For full terms and conditions please visit our website at: www.ngvwifi.com.au
  13. Fair & Acceptable Use Policies apply.
  14. The Principal Carriers that own the networks that NGV utilise to provide consumers their agreed services are Telstra, Vocus Communications, AAPT, Exetel and Superloop.
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