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HaleNET ADSL Signup Form

Please feel free to contact HaleNET if you need any assistance in completing this application. By submitting this application you are entering into a contract with us for us to supply you with an ADSL service. As there are third party providers involved in providing this service it is very important that any questions are sorted out before the application goes ahead. Thankyou for completing this application.

In order to be able to apply for this service the person completing the form must be 18 years of age or older (more mature)


Details of Person completing this application
Your HaleNET Username or a valid email address:
First Name
Last Name
I have read and understand the terms and conditions associated with applying for a HaleNET ADSL service.
 
Phone Line Details
 
The Telstra phone account account name.
Phone Number for the ADSL Service
Street Number
Street Name
Town, Suburb or City
State.
Postcode
 
Postal Address
 
Postal Steet Number
Postal Box Number
Town Suburb or City
State
Postcode
 
Contact Phone Number
 
Contact Phone Number
 
Connection Details
 
Requested Connection Date
Please Select the Requested ADSL Connection
* Subject to Fair Use Policy. See terms and conditions.
 
By submitting this application I agree to be bound by the terms and conditions as well as to pay all charges.


Thankyou for filling out this application. It is much appreciated

 

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