Internet Registration
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100 HOURS TRIAL REGISTRATION DETAILS
First Name:
Last Name:
Company Name:
Street Address:
Suburb/Town:
State:
Postal Code:
Phone:
Fax:
Preferred Username:
(Maximum of 8 alpha/numeric characters. We cannot promise your requested
username but will try to allocate one as close as possible.)
Preferred Password:
(Must be 6-8 alpha/numeric characters and contain at least one numeric digit.
This password can be changed at any time, by yourself, on-line.)
Operating System:PC Win 95PC Win 3.xx
Select Your Nearest Dial Up Location:
Serial No. Found On CD Pack:
 Read Terms & Conditions NOW!
 I have read and agreed to the terms & conditions of use
as stated on this CD:
Signature:
Date:
  
100 HOURS TRIAL REGISTRATION PAYMENT DETAILS
Please Note: Registration without payment will not be processed; Administration Fee is non refundable; TPG Internet Access Hours are valid for the hours specified or for a period of 30 days or by 31 July 1998, whichever is reached first; hours start from the date you first logon to the internet; Accounts will be automatically terminated after hours have been utilised, so make sure you renew for more hours.
100 Hours  for 30 Days  = $30 Registration Fee
Cheque/Money Order Payable To TPG Internet Pty Ltd
Debit My Credit Card
 BankcardVisaMastercardAmex
Card Holder's Name:
Card No:
Expiry Date:
Signature:
Date:
  
REPLY OPTIONS
  1. MAIL: Paying By Cheque Then Print & Mail This Form To: TPG Internet Pty Ltd, 65 Waterloo Road, NORTH RYDE NSW 2113
  2. FAX: Paying By Credit Card Then Print & Fax This Form To: TPG Internet Pty Ltd Fax: 02 9850 0813
  3. EMAIL: Paying By Credit Card Then Email This Form To: promo1@tpgi.com.au
  4. PHONE: Paying By Credit Card Then Call TPG Internet Pty Ltd On 1300 360 855
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