Simple Phone Line Application Form

1. I will relinquish any contractual rights with my current service provider, including, but not limited to discount plans.

2. Some functions and facilities that are available through your current service provider may not be available from your new serviceprovider.

3. When porting your service from your current telephone or broadband (DSL) provider to your new service provider this may result infinalisation of your account for those services and though you have the right to Port your service, you are aware that there may be earlytermination charges and porting fees.

4. Queries in relation to faults or service provision must be directed to your current service provider until the transfer is affected.

5. In relation to my long distance selection above, I understand that if I have not selected a provider that it will default to BKB Internet PtyLtd and its nominated long distance carrier.

6. This Customer Authorisation is valid for 30 days from the date of signing, for a ULLS Port, however I understand that if needed I authorisethe Authority to be automatically extended by a further 30 days. An authorisation for change of Long Distance Pre-Selection is valid for 30days, however I understand that if needed I authorise the Authority to be automatically extended by a further 60 days. A Local Call Churnand Broadband Churn authority is valid for 30 days.

7. A Local Call Churn can take up to 40 business days to become effectiveAgreement

• I the undersigned have read and accept the BKB Internet Terms and Conditions, Acceptable Use Policy and Spam Policy (located athttp://www.bkb.net.au/).
• I have read and understood the information about BKB Internet’s handling of information about me (personal information).
• I give BKB Internet consent to obtain and use credit information about me, including information about my credit history.
• I understand that once an application is made it cannot be terminated without paying a cancellation / termination fee.
• 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 allof the information I have provided is true and correct.
• 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 ifthis application is rejected.