TPG 100 HOUR TRIAL PACK
First Name:
Last Name:
Company Name:
Street Address:
Suburb/Town:
State:  Post Code:
Phone:
Fax:
Select Your Nearest TPG Dial Up Location:
Who Is Your Preferred TPG Reseller:
Preferred Username 1:
Preferred Username 2:
  (Maximum of 8 alpha/numeric characters. Your requested username is not guaranteed.)
Preferred Password:
  (Must be 6-8 alpha/numeric characters and contain at least one numeric digit. Password can be changed any time, by yourself at www.tpg.com.au. Please Note: Remember your password as this will not be printed on your TPG confirmation sheet)
Operating System: Win 95   Other:
  Read Terms & Conditions NOW!
  I have read and agreed to the standard Terms & Conditions of use as stated on this CD:
Signature:
Date:
   
PAYMENT DETAILS
TPG 100 Hour Trial Pack: A Administration Fee of $30 is applicable; Registration without payment will not be processed; Administration Fee is non refundable; TPG Internet Access Hours are valid for the hours specified or for a period of 30 days whichever is reached first; hours start from the date you first logon to the Internet; Accounts will be automatically terminated after hours have been utilised, so make sure you renew for more hours
TPG 100 Hour Trial Pack  Valid For 100 Hours OR 30 Days  + $30 Administration Fee
Cheque/Money Order Payable To TPG Internet Pty Ltd
Debit My Credit Card
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Card Holder's Name:
Card No:
Expiry Date:
Signature:
Date:
   
REPLY OPTIONS
  1. FAX: Paying By Credit Card Then Print & Fax This Form To: 02 9850 0813

  2. E-MAIL: Paying By Credit Card Then E-mail This Form To: promo1@tpg.com.au

  3. POST: Paying By Cheque/Money Order Then Print & Mail This Form Together With Payment To: TPG Internet Pty Ltd, 65 Waterloo Road, NORTH RYDE NSW 2113