Application for Dialup Internet Access

Please provide your details below. You can also apply by telephone to 1300 138 977 or email helpdesk@cyberq.net.au
Your Details
Name*
Telephone*
Mobile
Other Phone
Address*
Preferred User ID*
Min. 3 characters - User ID becomes your email address ie; jcitizen@cyberq.net.au
Second Preference
Email Suffix		@cyberq.net.au @cyberspace.net.au
Preferred Password (may be amended to conform to our security)
Current Email Address (if applicable)
Email Aliases (if required) an alias allows you to use more than one address for the same email account
Plan* Some plans are subject to a maximum continuous connection limit of 4 hours thereafter allowing reconnection after 20 minutes.
CyberCore $19.95 /month for unlimited time and unlimited downloads. Credit card customers only. Other Plan Please detail the plan name
Payment
CREDIT CARD BANK DEPOSITINVOICE^ Bank deposit and Invoice methods are to approved customers and/or plan types. Your Credit Card number will be obtained from you by our Helpdesk to ensure your security. ^Invoiced accounts available to approved customers only & an administration charge may apply.
Referrals
Enter the person's name, email address or Promotion code eg: Joy Melbourne
Comments
I understand that by submitting this Application to STEAL INTERNET PTY LTD ACN 109 217 585 trading as CyberQ, I acknowledge that I have read the Terms and Conditions in full, relating to access to the Internet system, and agree to be bound by them whilst I remain a subscriber to these services.