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Mobile Broadband Application Form
Your Details
Name
First
Last
Address
Street Address
Address Line 2
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Virgin Islands, U.S.
Yemen
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Country
Home Phone
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Address History Details
Have you been living at your current address for less than 2 years?
Yes
No
Address
Street Address
City
State / Province / Region
Zip / Postal Code
Please enter your previous address.
Identity Verification Details
Please provide proof of your identity
Drivers Licence Number
State
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Date of Birth
MM
DD
YYYY
Employment Details
Please provide your current Employment Details
Employer
Address
Street Address
City
State / Province / Region
Zip / Postal Code
Length of Employment
eg: 1 year 2 months
Wireless Broadband Service Details
Wireless Setup Option
No Contract - BYO Modem - $25 Setup Fee
No Contract - Modem Inc - $169 Setup Fee
24 Mth Contract - Modem Inc - $0 Setup Fee
Rate Plans
Preferred Rate
Standard Rate
Preferred Rate offers you a discount on your monthly fee for choosing to pay via automatic payment and to accept your invoices electronicaly.
BKB Preferred Rate Conditions
Customer must pay by Visa / MasterCard on Automatic Payment
Customer must accept electronic invoicing (PDF invoices email to their nominated email address)
Preferred Rate Mobile Broadband Plans
Mobile Broadband .2GB - $14.95
Mobile Broadband 1GB - $19.95
Mobile Broadband 3GB - $29.95
Mobile Broadband 6GB - $44.95
Standard Rate Mobile Broadband Plans
Mobile Broadband .2GB - $24.95
Mobile Broadband 1GB - $29.95
Mobile Broadband 3GB - $39.95
Mobile Broadband 6GB - $54.95
Agreement
I the undersigned have read and accept the BKB Internet terms and Conditions, Acceptable Use Policy and Spam Policy (located
here)
I have read and understood the information about BKB Internet's handling of information about me (personal information).
I agree that by signing of this form, BKB Internet Pty Ltd is under no obligation to accept my application until they are satisfied that all of the information I have provided is true and correct.
I understand that once an application is made it cannot be terminated without paying a cancellation / termination fee.
Notice and Agreement to disclosure of your personal and credit information to a credit reporting agency. (Privacy Act 1998 as amended)
I understand that BKB Internet is asking me for personal information about me so as to use Veda Advantage’s credit reporting service to credit check me. I understand that:
Veda Advantage will give BKB Internet information about me for that purpose.
BKB Internet will give my personal information to Veda Advantage, and that Veda Advantage will hold that information on their systems and use it to provide their credit reporting service.
When other Veda Advantage customers use the Veda Advantage credit reporting service, Veda Advantage may give the information to those customers.
BKB Internet may use Veda Advantage’s credit reporting services in the future for purposes related to the provision of credit to me. This may include using Veda Advantage’s monitoring services to receive updates if any of the information held about me changes.
If I default in my payment obligations to BKB Internet, information about that default may be given to Veda Advantage, andVeda Advantage may give information about my default to other Veda Advantage customers.
I acknowledge that this service has been designed as a residential product. While all effort has been made to make the experience as enjoyable as possible, the service does not offer the QoS or SLA guarantees that Business Grade services offer.
Finally I agree to pay BKB Internet Pty Ltd the fees above as a part of this application and understand that a full refund will be made if this application is rejected.
Acceptance of Agreement
*
I agree to and accept all terms of the above agreement
Do you have any questions that I can help you with?
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