Ugly Bill For Cheap Residential and Business Telephone Calls , Discount International Rates, 1300 1800 Number

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ADSL Churn Authorisation

By completing and signing this form, you are agreeing to transfer your DSL service from your current supplier to Cybertel Telecom Pty Ltd.

Section 1 – Account Details:

Do you have an existing Cybertel Telecom Pty Ltd account?

Yes - Account Number:

No – (go to section 2)

Section 2 – Customer Details:

New Service Transfer Existing

Business Name / Legal Entity:

Title or Position:

First Name:

Last Name:

ABN / ACN (bus):

or DOB (pvt):

Service Address:

Postcode:

State:

Billing Address:

Postcode:

State:

Telephone:

Fax:

Email Address :

Section 3 – Service Details:

New Service Transfer Existing

Line Number :

This is the line number you wish to have the service installed on.

Existing Carrier (if applicable):

Existing Carrier account No:

Residential Service

Business Service (static IP)

Plan Name select a plan from the dropdown box

Supply Modem (inc 1 Filter) Number of Additional Filters Required:

Transfer Existing $59.00

Modem Cost:

Send Application

Please tick the check box to acknowledge you have understood and agree to the Ugly Bill Terms and Conditions

Please check that you have completed all the requested information for the services you require. If you require further information or assistance please do not hesitate to contact us at any time on 1300 789 084

Please enter the following letters into the box below before submitting

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	Ugly Bill is a trading name of Cybertel Telecom Pty Ltd Head Office - Suite 9, 23 Middle Street Cleveland. PO Box 502, Cleveland, Qld 4163 Email: info@uglybill.com

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