Pricing has changed, refer to updated pricing

Your Internet Connection
Dialup Application

Note: This is not an online application form. To use this, Print out the document, and Fax to (02) 9922 5256 or mail to PO Box 544, North Sydney NSW 2059.
Contact Details
Organisation Name
Administrative Contact Phone
Technical Contact Phone
Fax Mobile/Pager/Email
Street Address Suburb Postcode
Postal Address Suburb Postcode
System Information
User name preference Password Preference
(Must start with an alphabetic character and be 3-8 characters long. Your email address will be username@netro.com.au) (Password must be 6 to 16 characters long. For security, do not use a word in the dictionary)
Operating System
eg Win3.1, 95, NT)		 Modem
eg Hayes 33.6, Banksia 28.8
Subscription Plans
Account

Mailbox

 Casual Regular Business Frequent
Registration (Req’d) $25

$25

$25

$25

$25

Year $120

$240

$360

$540

$780
Quarter $36

$75

$105

$150

$210

Month $15

$30

$40

$55

$75
Modem (Hayes Accura 56k Data/Fax)

$245

Delivery $10

Payment Options

Amex

Visa

Diners

Purchase Order

Mastercard

Bankcard

Cheque

Money Order

Credit cards will be debited as per the subscription plan and period chosen above, unless notification is received in writing. All Purchase Orders must acknowledge Netro’s standard 7 day payment terms unless a credit application has been received and approved.
  Cardholder :   Cardnumber:   Expiry :
Invoicing Preference Referred by:
Post, Fax or Email. If Email, then please write the name and version of your spreadsheet software. (eg: Excel 97) Customers who refer clients to Netro will receive a $20 credit to their account.
Declaration
I hereby agree to Netro’s Terms and Conditions and authorise my credit card (if applicable) to be deducted the amount below. I am above 18 years of age.

Total

Signature

 

Date

Please fax to (02) 9922 5256 or mail to PO Box 544 North Sydney 2059.

Copyright © 1998 all rights reserved.