Available in Sydney, Penrith, Melbourne, Brisbane, Canberra, Adelaide and Perth
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)
I have read and agreed to the Product Conditions and the standard Terms & Conditions of use as stated on this CD:
Signature:
Date:
PAYMENT DETAILS
Value Pack: Conditions Apply; Renewals are of a three-month period; The administration fee will not be waived if you have other premium or trial packages; No Administration Fees apply to credit card holders when renewing the TPG Value Pack; Other forms of payment will carry subsequent Administration Fees of $30 for each quarterly renewal; For credit card Subscribers TPG Internet will automatically renew your subscription for the next three months, debiting the subscription charges from the credit card provided unless written notice of termination is received at least two weeks prior to the expiration of the then current subscription; For other forms of payment, it is the Subscribers responsibility to contact TPG to renew their subscription for the next three-month period; TPG may not necessarily contact the Subscriber to advise renewal
TPG Value Pack
Unlimited 3 Hour Sessions x 3 Months
$19.95 Per Month + $30 Admin Fee Once Off With Credit Card $89.85
Cheque/Money Order Payable To TPG Internet Pty Ltd
Debit My Credit Card
BankcardVisaMastercardAmex
Card Holder's Name:
Card No:
Expiry Date:
Signature:
Date:
REPLY OPTIONS
FAX: Paying By Credit Card Then Print & Fax This Form To: 02 9850 0813
E-MAIL: Paying By Credit Card Then E-mail This Form To: promo1@tpg.com.au
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
