Applicant name Are you an exsisting Titan Internet customer Exsisting New Customer First name * Surname * Telecom account holder: First name * Surname * Is your Telecom account Residential or Commercial? Residential Commercial Telecom Account number * (9 digits) (Where Telecom charges apply, this is the account the product or Service will be charged to. It is printed on the top right hand corner of the first page of every Telecom account) Your Titan Internet username ( Note if you are a new customer please indicate your preferred username ) * Email address * Contact Details Business number * Business Fax number After Hours Contact Number * Current Postal Address ( Street ) * PO Box Suburb * Town / City * Service Request details Phone number the FastADSL service is to be connected on * I want to be installed on a new line. Yes No Select Jetstream pricing option (choose one) Standard price including installation charge of $300 inc GST, no fixed term of agreement JetStream 400 - 400 Mb / month Jetstream 600 - 600 Mb / month Jetstream 1500 - 1500 Mb / month Jetstream 3000 - 3000 Mb / month Jetstream 5000 - 5000 Mb / month Jetstream 10000 - 10000 Mb / month Best time to call 9:00 am to Midday Midday to 5:00pm What date would you like Telecom to contact you? Computer system Information Are you using a PC or Mac? Pc Mac What operating system are you running? Do you have more than 30 Megs Hard drive spare? Yes No Don't Know How much ram do you have? Don't Know What type of processor are you running: Don't Know Computer Manufacturer (Make): Don't Know What computer model is it? Don't Know Configuration options (For an external ADSL modem) Is your computer connected to a network? Yes No Don't Know Do you have an installed Ethernet Card? Yes No Don't Know If no do you want Telecom to supply the Ethernet Lan card? Yes No Don't Know Do you have a spare PCI Slot? Yes No Don't Know Third-party modems If you have or are going to buy your own ADSL modem, what make/model is it? Make/Vendor: Model: Additional information or comments: ©1999 TiTAN Internet Ltd. All Rights Reserved. Terms and Conditions.
Applicant name
Are you an exsisting Titan Internet customer
Exsisting New Customer
First name
*
Surname
Telecom account holder:
Is your Telecom account Residential or Commercial?
Residential Commercial
Telecom Account number
* (9 digits)
(Where Telecom charges apply, this is the account the product or Service will be charged to. It is printed on the top right hand corner of the first page of every Telecom account)
Your Titan Internet username ( Note if you are a new customer please indicate your preferred username )
Email address
Contact Details
Business number
Business Fax number
After Hours Contact Number
Current Postal Address ( Street )
PO Box
Suburb
Town / City
Service Request details
Phone number the FastADSL service is to be connected on
I want to be installed on a new line.
Yes No
Select Jetstream pricing option (choose one)
Standard price including installation charge of $300 inc GST, no fixed term of agreement
JetStream 400 - 400 Mb / month Jetstream 600 - 600 Mb / month Jetstream 1500 - 1500 Mb / month Jetstream 3000 - 3000 Mb / month Jetstream 5000 - 5000 Mb / month Jetstream 10000 - 10000 Mb / month
Best time to call
9:00 am to Midday Midday to 5:00pm
What date would you like Telecom to contact you?
Computer system Information
Are you using a PC or Mac?
Pc Mac
What operating system are you running?
Do you have more than 30 Megs Hard drive spare?
Yes No Don't Know
How much ram do you have?
Don't Know
What type of processor are you running:
Computer Manufacturer (Make):
What computer model is it?
Configuration options
(For an external ADSL modem)
Is your computer connected to a network?
Do you have an installed Ethernet Card?
If no do you want Telecom to supply the Ethernet Lan card?
Do you have a spare PCI Slot?
Third-party modems
If you have or are going to buy your own ADSL modem, what make/model is it?
Make/Vendor:
Model:
Additional information or comments:
