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 95
PC Win 3.xx
Select Your Nearest Dial Up Location:
NSW Sydney: 02 9878 0400
NSW Albury: 02 6040 6113
NSW Armidale: 02 6771 4999
NSW Bathurst: 02 6332 9455
NSW Coffs Harbour: 02 6651 7388
NSW Dubbo: 02 6884 4305
NSW Goulburn: 02 4822 4433
NSW Kiama/Wollongong: 02 4232 3615
NSW Lake Macquarie/Newcastle: 02 4958 8280
NSW Tamworth: 02 6766 3083
NSW Taree: 02 6551 6522
NSW Tumut: 02 6947 6133
NSW Wagga Wagga: 02 6931 7047
ACT Canberra: 02 6282 8233
QLD Brisbane: 07 3257 1389
QLD Ayr: 07 4783 6416
QLD Biloela: 07 4992 5299
QLD Bowen: 07 4786 4457
QLD Bundaberg: 07 4151 8611
QLD Cairns: 07 4041 1311
QLD Emerald: 07 4982 4537
QLD Gladstone: 07 4972 6022
QLD Gympie: 07 5482 2963
QLD Longreach: 07 4658 0100
QLD Mackay: 07 4944 0255
QLD Mareeba: 07 4092 5399
QLD Mt Isa: 07 4743 6028
QLD Proserpine: 07 4945 3699
QLD Rockhampton: 07 4922 4850
QLD Roma: 07 4622 6088
QLD Southport: 07 5531 2622
QLD Toowoomba: 07 4639 5168
QLD Townsville: 07 4723 9874
VIC Melbourne: 03 9681 9566
VIC Ballarat: 03 5332 3932
VIC Bendigo: 03 5441 7144
VIC Geelong: 03 5224 2025
VIC Leongatha: 03 5662 4666
VIC Lilydale: 03 9735 4655
VIC Sale: 03 5144 1455
VIC Shepparton: 03 5831 8102
VIC Warragul: 03 5623 6920
VIC Warrnambool: 03 5561 6107
SA Adelaide: 08 8212 0442
WA Perth: 08 9244 7000
WA Broome: 08 9192 1199
WA Bunbury: 08 9791 5022
TAS Hobart: 03 6224 4839
TAS Launceston: 03 6334 9635
NT Darwin: 08 8941 2922
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
Bankcard
Visa
Mastercard
Amex
Card Holder's Name:
Card No:
Expiry Date:
Signature:
Date:
REPLY OPTIONS
MAIL:
Paying By Cheque Then Print & Mail This Form To: TPG Internet Pty Ltd, 65 Waterloo Road, NORTH RYDE NSW 2113
FAX:
Paying By Credit Card Then Print & Fax This Form To: TPG Internet Pty Ltd Fax: 02 9850 0813
EMAIL:
Paying By Credit Card Then Email This Form To: promo1@tpgi.com.au
PHONE:
Paying By Credit Card Then Call TPG Internet Pty Ltd On 1300 360 855