Telecommunication Solution - Customer Account Sign Up

Product and Services

Better Telecom NEW Customer Account Sign-Up

Account Type

Business
Personal

Account Details (Must be physical address not PO Box)
Position
Salutation
First Name
Middle Initial
Last Name
Phone
Fax
Mobile
Email
Date of Birth
(Used for verification of your identity when you call us)
Number
Street
City
State
Country
Postcode

Billing Address Use Account Contact
Position
Salutation
First Name
Middle Initial
Last Name
Phone
Fax
Mobile
Email
Date of Birth

Number
Street
City
State
Country
Postcode

Email

Password

Confirm Password

Registered company or Business Name

ABN No.

Payment Information

Payment Type

Card Number

Name on Card

Expiry Month

Expiry Year

CCV

(CCV is a 3 digit code appearing on the back of your credit card, at the end of the number printed on the signature strip. AMEX card holders this is a 4 digit code printed on the front of your card)

Enter Your Services Below Note: We will call you to confirm best plan options before proceeding with this application. Please enter a service.
Number	Service Type	Plan	Additional Info
			ISDN Range Start ISDN Range End
			ISDN Range Start ISDN Range End
			ISDN Range Start ISDN Range End

I understand Better Telecom will be my supplier for all telephone services including rental, local calls, long-distance, fixed to mobile, and international calls. I have read and agree to the Standard Terms and Conditions.

I am the telephone account holder or am authorised to switch the above services to Better Telecom.
I authorise Better Telecom to take any further action, including signing documents on my behalf, to provide this service.
The information provided on this form is true and correct.
I am under no contract to remain with Better Telecom. However, I will inform Better Telecom in advance if I decide to change providers.
I understand that Better Telecom Payment Terms are 14 days from invoice date.