TPG Manual Registration Form

Register Manually

TPG Modem + Value Pack Registration Form

First Name:

Last Name:

Company Name:

Street Address:

Suburb/Town:

State:

Postcode:

Phone:

Fax:

TPG Location:

P=Premium Service V=Value Service M=Metro Service

Username: Maximum of 8 alpha/numeric characters. Check Username.

Username:

Password: Must be 6-8 alpha/numeric characters and contain at least one numeric digit.

Password:

Re-Type Password:

TPG Modem + Value Pack					V

Monthly Hours	Monthly Cost	Admin Fee	Download Monthly Limit	Extra Download Charge	Total Cost
Unlimited	Nil	$43.95	300Mb	18c/Mb	$43.95 For 6 Months
These prices include GST * Conditions Apply; Unlimited 3 hour sessions; Billed in advance; Administration fees are non refundable; Available in Sydney, Gosford, Kiama/Wollongong, Lake Macquarie/Most Newcastle Areas, Penrith, Melbourne, Brisbane, Southport/Gold Coast, Canberra, Adelaide, Perth, Hobart, Launceston and Darwin metro areas

I have read and agreed to the package conditions and the standard terms & conditions of use as stated on these pages:

Signed:

____________________________________

Dated:

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:

Enter Card Number and Expiry Date as seen on your Credit Card

Complete Registration Form, Print and Mail to:

TPG Internet Pty Ltd
65 Waterloo Road
NORTH RYDE NSW 2113

E-MAIL CONFIRMATION: To receive confirmation of registration via E-Mail enter a current E-Mail Address here: