Application for Email Only Account

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 Email address*
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
Price Email only accounts are $5.00 per month.
Payment
CyberQ will contact you to obtain your Credit Card number upon receipt of this application.
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.