Internet Registration

100 HOURS TRIAL REGISTRATION DETAILS
First Name:
Last Name:
Company Name:
(optional)
Street Address:
Suburb/Town:
State:  Post Code:
Phone:
Fax:
Select Your Nearest Dial Up Location:
Who Is Your Preferred TPG Internet Reseller:
Preferred Username 1:
Preferred Username 2:
  (Maximum of 8 alpha/numeric characters. Your requested username is not guaranteed.)
Preferred Password:
  (Must be 6-8 alpha/numeric characters and contain at least one numeric digit.
Password can be changed any time, by yourself at www.tpg.com.au.)
Operating System: Win 95Win 3.xx
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, whichever is reached first; the time period is calculated from first access date; Accounts will be automatically terminated after hours have been utilised, so make sure you renew for more hours.
Trial Package 100 Hours  Valid For 30 Days  = $30 Registration Fee Only
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: 02 9850 0813

  3. E-MAIL: Paying By Credit Card Then E-mail This Form To: promo1@tpg.com.au

  4. ONLINE REGISTRATION: Paying By Credit Card Then Go To TPG Secure Server
    Please note: If registering online you must be connected to the Internet first