Creative Telcom - Business Sign Up

To transfer to our quality service from your existing carrier simply fill in the form below & submit your registration.

Company name:

Company Contact First name:

Company Contact Last name:

Business Address/Street:

Postcode:

City/Suburb:

Postal Address/Street:

Postcode:

A/H Contact Telephone#

B/H Contact Telephone#

E-mail:

(Your monthly bill with be emailed to this address, unless you select the mail bill option below)

Drivers license#:

Credit Card #:

Credit Card Type:

Last monthly bill:

Date of birth:

Telephone numbers to connect
(fill in the phone number including the area code without the zero before the area code):

Telephone number #1:

Telephone number #2:

Telephone number #3:

Countries most frequently called

Country #1:

Country #2:

Recommended by:

Please put the persons telephone number

Current local call carrier:

(eg Telstra, Optus etc)

Current long distance carrier:

(eg Telstra, Optus etc)

Delivery method of statement (emailed or mailed on the anniversary day each month):
(Please choose one)

via email address above (Free)
via postal address ($3.00 ex. GST per month)
via both ($3.00 ex. GST per month)

Please specify which payment method you will be using to pay your monthly account:
(Please choose one)

	Credit card (Form here)
	Direct debit (Form here)

Do you also want to become a pre-selected customer?

	Yes, I want to become a pre-selected customer for national & international phone calls & calls to mobile.
	Yes, I want to become a full service customer for all local, national, international & calls to mobile, including the line rental charges on one bill.
	Please also provide me with an internet connection - I would like one of your consultants to contact me & tell me about this month’s specials.