Account Application Form
 
Thank you for choosing Ugly Bill (ABN: 28 898 453 609). All information provided by you is held in strict confidence by Ugly Bill and is not used for any purpose other than the direct provision and support of Ugly Bill business communications and associated services.
 
Please complete this part of the form before continuing
Do you have an existing Ugly Bill account?
Yes:      Account Number:        Please go to step 2
No – please ensure all details are filled in below
Company/Business Name (If applicable):
Company/Business ABN:
Customer Name or Authorised Person for above entity:
First Name: Middle:
Last Name:
Individual ABN (If Applicable):
Date of Birth:               
Email Address :
Service Address:
Suburb: State:
Contact Telephone: Post Code:
 
Please click on the following service you require (the heading will expand to reveal the form) and then complete the relevant sections: (for a description of each see our Home page).
 ADSL
# ADSL
Option 1 - Please select if you require a new ADSL service: fill in New ADSL Service form below
Option 2 - Please select if you require an existing ADSL service churned from your current provider to Ugly Bill: click here to proceed to form
Option 1 – New ADSL Service:
Is there an alarm service on this line:       Yes             No
Line Number:

Residential or             Business Service

 
Choose a ADSL Plan from the following:    
Data Allowance means: peak + off peak. Peak = 12.00pm to 11.59pm, Off Peak 12.00am to 11.59am.
Shaped means: 64 Kbps download / 64 Kbps upload
Speed means: download / upload
New Service Establishment Charge $129.
  • I understand that I am on a Ugly Bill plan detailed above which I have reviewed at www.uglybill.com.
  • I have read and agreed toUgly Bill’s Terms and Conditions as published at www.uglybill.com.
  • I understand that rates and costs are inclusive of GST, as published online at www.uglybill.com.
  • I understand Ugly Bill may perform a credit check upon application.
  • I understand that I am under a minimum 6-month contract and I will incur a $77.00 cancellation fee if I cancel within this period.
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
Have you completed all the services you require?    Please click here
 
Option 2 – Existing ADSL service churned from your current provider to Ugly Bill:
Current Carrier:
Account number:
Current Plan/Speed:
Is there an alarm service on this line:       Yes             No
Line Number:

Residential or             Business Service

 
Choose a ADSL Plan from the following:    
Data Allowance means: peak + off peak. Peak = 12.00pm to 11.59pm, Off Peak 12.00am to 11.59am.
Shaped means: 64 Kbps download / 64 Kbps upload
Speed means: download / upload
Service Churn Fee $59.
  • I understand that I am on a Ugly Bill plan detailed above which I have reviewed at www.uglybill.com.
  • I have read and agreed to Ugly Bill’s Terms and Conditions as published at www.uglybill.com.
  • I understand that rates and costs are inclusive of GST, as published online at www.uglybill.com.
  • I understand Ugly Bill may perform a credit check upon application.
  • I understand that I am under a minimum 6-month contract and I will incur a $77.00 cancellation fee if I cancel within this period.
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
Have you completed all the services you require?    Please click here
 Authority To Change Provider
# Authority To Change Provider
Section 1 – Service Number Details:
Please write telephone number(s) below indicating your choice of Ugly Bill as your preferred provider of pre-selectable and local telephone services.
Line Hunt:    PLEASE LIST NUMBERS IN LINE-HUNT ORDER – PLEASE PRINT CLEARLY!
Area Code
Number
Area Code
Number
       
Section 2 – Agreement and Authority:

I certify that I have the authority to authorise this change 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 this number.

I authorise Ugly Bill to take any further action required, including signing any documents on my behalf, to give effect to this charge.
Have you completed all the services you require?    Please click here
 New Line Installation
# New Fixed-Line Installation Application
Section 1 – New Line Location Details:
Location Name / Building Name:
Service Address: Postcode:   State:   
First Name: Last Name:
Telephone: Number of Lines Required:
Connection Charges: Inactive in-place line $59.00 No in-place line, new copper required $299.00
Value Added Services:             Messagebank         Silent Number          Call Waiting
Additional Information: Title or Position:
Have you completed all the services you require?    Please click here
 1300 & 1800 Numbers
# 1300 & 1800 Numbers
On selecting this service you are agreeing that you have read our Terms and Conditions and you are the authorised person applying for this service.
Please enter the 1300 or 1800 Number you are porting or if you require a new number, simply enter 'New 1300' or 'New 1800'
Please enter the answering point (include area code) (being your telephone or mobile number)
If the above 1300 or 1800 Number is currently activated, please provide the name of your carrier and account number:
Current 1300/1800 Carrier:
1300/1800 Account Number:
Name of Account Holder:
When would you like Ugly Bill to activate this service: (It may take up to five working days to activate, but usually within 24hours)

                ASAP          or specific date  
Have you completed all the services you require?    Please click here
 Live Operator
# Live Operator
On selecting this service you are agreeing that you have read our Terms and Conditions and you are the authorised person applying for this service.
Please provide the telephone number you require to be answered by the Live Operator Number:
Do you require all calls to be immediately diverted, giving you no opportunity to answer:
Do you require calls to be diverted to the Live Operator after 10 seconds:
Please enter the name that the calls have to be answered in, usually your Business/Company name
Or if you require a more complex configuration or a more detailed answer message please contact us to discuss.
Do you require call details to be forwarded to:
Your email: Your mobile: Or both:
Have you completed all the services you require?    Please click here
 VoiceFax2Email
# VoiceFax2Email
On selecting this service you are agreeing that you have read our Terms and Conditions and you are the authorised person applying for this service.
Please provide the telephone number you require to be answered by your recorded message (ie your 1300 or 1800 Number) :
The caller's message will be sent to the following:
Your email: Your Fax number (include area code) : Or both:
On acceptance of this application, we will send you details of how to leave your personal message.
Have you completed all the services you require?    Please click here
 Mobile Phone
# Mobile Phone
On selecting this service you are agreeing that you have read our Terms and Conditions and you are the authorised person applying for this service.
Option 1 - Please select if you require a new mobile number :
Option 2 - Please select if you wish to keep your current mobile number:
The Customer understands that by completing Option 2, they are nominating Ugly Bill (ABN: 28 898 453 609) as the preferred carrier for the following mobile telephone number(s) and Ugly Bill will become the carrier of choice for all calls, including any other pre-selectable services charged to the mobile number(s).
Please enter the name of your current carrier:
Name of Account Holder:
Account Number or type 'Prepaid':
The Customer certifies that by completing this section they have the authority to authorise the change of provider for the following mobile number(s) and they nominate Ugly Bill as the preferred carrier for the mobile number(s) listed below:
  Mobile Number: Mobile Number:
  Mobile Number: Mobile Number:
On acceptance of your application, we will send you a new sim card, along with activation instructions. Prior to installing your new sim card you must contact our office on 1300 789 084 and we will confirm your account information. Thereafter your existing number will be ported over or if you requested a new number, this will be provided to you. We will automatically enable your mobile to have all available functions (ie sms, messagebank etc), unless otherwise requested by you.
Have you completed all the services you require?    Please click here
 
Statement

I understand that current rates are published online in the 'Call Charges' page of this website. I understand Ugly Bill may perform a credit check upon application. I am not under any contract and I will inform Ugly Bill if I decide to change my service.

I request that Ugly Bill, under User ID 056103, arrange for funds due for payment to be debited from my account detailed below under the Direct Debiting System.

This authorisation is to remain in force in accordance with the terms described in the Customer Service Agreement, a copy of which I have read on the 'How 2 Join' page of this website.

Direct Debit:

Ugly Bill will send you a Tax Invoice in the first week of each month and the amount due will be debited from your nominated bank account or credit card on or around the 20th of that month.

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

Name of Financial Institution
(eg: Commonwealth, Westpac etc):
Branch - Name/Address:
Account Name:
BSB Number:
Account Number:


Please note: If you are unsure of your correct BSB and/or Account number please contact your financial institution or check your latest bank statement.

If payment is not received via the above Direct Debit, then payment will be debited from a nominated Credit Card. On receiving this application one of our staff will contact you for your credit card details.

Send Application

Please tick the check box to ensure that you have filled in all details correctly in Step One

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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