Account Application & Authority To Change Provider Of Telephone Changes
 
Thank you for choosing Ugly Bill as your full service telecommunications service provider. All information provided by you is held in strict confidence and is not used for any purpose other than the direct provisioning and support of telecommunications and associated services.
Section 1 – Customer Account Details:
New Account Existing Account Account: 
Business Residential Plan:        
Section 2 – Customer Details:
Customer / Legal Entity: Telephone:
Trading Name (if applicable): Fax:
ABN (Business): Email:
Service Address: Date of Birth:
Postal Address: Contact Person:
Section 3 – Service Number Details:
Line Hunt   (Please list numbers in line-hunt order)    
Area Code
Number
Area Code
Number
Section 4 – Agreement and Authority:

I certify that I am the authorised account holder and these details are correct. I understand that by nominating Ugly Bill as the
preferred carrier for the telephone number(s) listed above, Ugly Bill will become the carrier of choice for the International and
National Long Distance Services, and any other pre-selectable services charged to these number(s).

I authorise Ugly Bill to take any further action required, including signing any documents on my behalf, to give effect to this
charge.
Agree       
Section 5 – Direct Debit Request (DDR) Authority:
Bill Buddy Pty Ltd (ABN 31 106 055 181) is Ugly Bill authorized DDR service provider.
Your Name:    ACN / ABN:

I request and authorise Bill Buddy Pty Ltd (the User)(User ID number 320813) to arrange for any amount Bill Buddy Pty Ltd may debit or charge you, on behalf of Ugly Bill, to be debited through the Bulk Electronic Clearing System from an account held at the financial institution identified below subject to the terms and conditions of the Direct Debit Service Agreement [and any further instructions provided below].

Please complete the following Direct Debit information if you wish to pay your account via your nominated Bank:

If you would prefer to make payments by means of a Direct Debit from your credit card, please leave the following boxes below blank. For security reasons we will contact you personally to arrange this facility.   Yes please arrange this facility

Details of Bank Account to be Debited:
Name of Financial Institution (e.g.: Commonwealth, Westpac etc):
Postal Address: BSB Number:
Account Holder’s Name: Account Number:
By submitting this Direct Debit Request you acknowledge having read and understood the terms and conditions governing the debit
arrangements between you and Bill Buddy Pty Ltd as set out in this Request and in your
Direct Debit Request Service Arrangement. Further, you expressly authorise Bill Buddy Pty Ltd to draw any
fees under clause 10 of the Direct Debit Request Service Agreement from the account nominated in this form.

Send Application

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

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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Direct Debit Service Agreement:
By submitting this Direct Debit Request you acknowledge and agree to the following terms & conditions:
  1. You authorise Bill Buddy to debit your nominated account in the manner specified by Ugly Bill. Ugly Bill is the organisation
    providing you with the service for which Bill Buddy is debiting your account.
  2. We will provide you with at least 14 days prior notice in writing if we propose to vary any of the terms of the debit
    arrangements in place between us.
  3. You should contact Ugly Bill if you wish to defer or alter any of the debit arrangements.
  4. You will need to advise Ugly Bill in writing if you wish to cancel a Direct Debit Request. Such notice should be delivered to us at least one working day before the due date for payment or as otherwise stipulated in our Terms and Conditions.
  5. If you wish to dispute any Debit Item you should refer to Ugly Bill and we will seek to resolve the matter with you. If we
    cannot resolve the dispute you can contact your financial institution at which your nominated account is held. Your financial
    institution will then commence a formal claims procedure on your behalf.
  6. Some financial institution accounts do not facilitate direct debits. If you are uncertain, you should check with your financial
    institution before signing a Direct Debit Request, to ensure that your nominated account is able to receive direct debits through the Bulk Electronic Clearing System.
  7. Before completing the Direct Debit Request, you should check the details of your nominated account against a recent
    statement from your financial institution, to ensure that your account details are correct.
  8. You agree that it is your responsibility to have sufficient cleared funds in your nominated account by the due date to enable
    payment of Debit Items in accordance with the directions of Ugly Bill.
  9. Bill Buddy will initiate the Debit Item on the due date as advised by Ugly Bill. If the due date for payment falls on a day which
    is not a business day in Queensland, then the Debit Item will be processed on the next business day. You should enquire directly with your financial institution if you are uncertain as to when the Debit Item will be processed to your account.
  10. If a Debit Item is returned unpaid by your financial institution, you authorise us to present a further debit for payment.
    Furthermore you authorise Bill Buddy to debit your account for any Dishonour Charge.
  11. Ugly Bill and Bill Buddy will ensure the details of your personal records and account details held by us remain confidential.
    However, if you lodge a claim in relation to an alleged incorrect or wrongful debit, it may be necessary for us to release such
    information to your financial institution or its representative, or to our financial institution or its representative to enable your
    claim to be assessed.
 
  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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