Username:  (4 to 8 characters)
 (Must start with and only contain letters. All characters must be in lower case)

 Password:    (4 to 12 characters)
 (Must start with a letter and can consist of letters and numbers. All letters must be lower case)

 Account Package: Choose your AussieISP Package $9.95 mth 50hrs/mth $18.95 mth Unlimited $55.00 qtr Unlimited $34.95 mth Perm 100mb $69.95 mth Perm Unlimited $1 per hr (DoV or ISDN) per 64k $149 mth (DoV or ISDN) per 64k

 First Name: Last Name:

 Address:   

 Suburb:      Sydney

 Post Code:

 Phone:       EG: (+61 2 987654321)

 Facsimile:  EG: (+61 2 123456789)

 Please enter an e-mail address below. This address should not be an AussieISP address. It   should be an alternative way to contact you via e-mail.

 Email Address:

Payment Information

  SELECT ONE:

  Credit Card Payment:

 Name on Card:  
 Card Number: 
 Card Exp:           

  Paying by Bank/Personal Cheque/Money Order:

 All cheques are to be made out to the following:-

AussieISP
PO Box 70
Blakehurst NSW 2221
AUSTRALIA.

 Please remember to add your username on the back of the cheque.
 Please note that applications will not proceed until payment is received.

Please add any comments or requests you have here.

 All services are subject to our Terms & Conditions. Please check and verify  this Order Form before you send it. If you agree with this statement, Terms  & Conditions and our Acceptable Use Policy and wish to finalise your Order,  then please click 'Yes, I Agree'. If you do not agree with anything here, or  do not wish to go ahead with your Order at this time, then please click 'No  Thank You'.

I agree to the above terms