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CONTACT DETAILS

PHONE
136361

FAX
1800677321

Register with DBNW

Simply fill and follow the details below to register with DBNW.

Account Holder Details:
Your Name:
Your Current Email address:
Address:
Suburb:
State:	PostCode:
Phone Number:
Fax Number:
Account Details:
Username (1st Choice):
Username (2nd Choice):
Password (optional)
Billing Plan:
Payment Method:
Credit Card Details:
Card Type:
Card Number:
Expiry Date:
Name on card:
System Details:
Operating System:
Internet Dialing Program:
Where did you hear about DBNW?	APC MAGAZINE

Please write the words "I AGREE" in the following box to acknowledge that you are at least 18 (eighteen) years of age (or are a parent/guardian agreeing) and accept the above statement and have read and agree to the terms and conditions, all charges and the acceptable use policy set forth by DBNW.

Now simply print this form off and fax it or send it to the DBNW offices. You will then receive confirmation of your registration at your current email address or via fax or post, at this point you account will be activated and the registration and applicable access fee debited.

Please make cheques/money orders out to "Dynamic Bell's Networld"
Send to: Locked Bag 2014, BROADWAY, NSW, 2007
Phone: 13 63 61 Fax:1800 677 321