TPG PREMIUM PACKAGES
First Name:
Last Name:
Company Name:
Street Address:
Suburb/Town:
State:  Post Code:
Phone:
Fax:
Select Your Nearest TPG Dial Up Location:
Who Is Your Preferred TPG 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 95   Other:
  Read Terms & Conditions NOW!
  I have read and agreed to the standard Terms & Conditions of use as stated on this CD:
Signature:
Date:
   
PAYMENT DETAILS
Premium Packages: Registration will not be processed without prior payment; An Administration Fee of $30 is applicable to the 120 Hour Package only; Administration Fees are non refundable; a Cancellation Fee of $50 is charged if an account is cancelled for any reason; unused monthly hours are not rolled over; the monthly time period is calculated from the date of the first access connection
120 Hour Package  Minimum 10 Hours Per Month  $120 + $30 = $150
240 Hour Package  Minimum 20 Hours Per Month  No Admin Fee = $240
600 Hour Package  Minimum 50 Hours Per Month  No Admin Fee = $300
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. FAX: Paying By Credit Card Then Print & Fax This Form To: 02 9850 0813

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

  3. POST: Paying By Cheque/Money Order Then Print & Mail This Form Together With Payment To: TPG Internet Pty Ltd, 65 Waterloo Road, NORTH RYDE NSW 2113