BUSHTECH

Name:*

Company Name:

Street Address:*

Suburb / City:*

State:

Postal Area Code:*

Phone Number of ADSL line:*

Mobile:

Plan Type:*

Modem:

	4-port Modem/Router	$110
	4-Port wireless Modem/Router	$140
	Wireless 4-Port/Voip Modem/Router	$250

Software:

Nod32 Anti Virus

$70 (12 months subscription)

Email 1:

@bushtech.com.au

Email 2:

@bushtech.com.au

Email 3:

@bushtech.com.au

Preferred Email Contact:

Payment Options*

Credit Card
Direct Debit
Invoice
Cash Advance or In person

Do you currently have an active ADSL service with another Provider? If Yes a $35 churn fee is required instead of a $99 activation fee

* Have you read and understood the Terms and Conditions? Terms and Conditions

Comments

(*) Required Fields

All Billing Information will be sent out to your preferred email address
A Bushtech Representative will contact you by phone within 48-hours to connect you. Typically, activations take five working days if successful.
For a more immediate connection, please call us now on (08) 8984 4158.

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BUSHTECH

Name:*

Company Name:

Street Address:*

Suburb / City:*

State:

Postal Area Code:*

Phone Number:*

Mobile:

Plan Type:*

Modem:

	Single-port Modem	$95
	4-Port Modem/Router	$140
	Wireless 4-Port Modem	$160

Software:

Nod32 Anti Virus

$75 (12 months subscription)

Email 1:

@bushtech.com.au

Email 2:

@bushtech.com.au

Email 3:

@bushtech.com.au

Preferred Email Contact:

Payment Options*

Credit Card
Direct Debit
Invoice
Cash Advance

Do you currently have an active ADSL service with another Provider? If Yes a $40 churn fee is required instead of a $99 activation fee

* Have you read and understood the Terms and Conditions? Terms and Conditions

Comments

(*) Required Fields

All Billing Information will be sent out to your preferred email address
A Bushtech Representative will contact you by ph