8 Market St.
  Ground Floor, 
  Melbourne, Vic. 
  3000 Australia

Wireless Capital 

SCHEDULE 1     Page 1 of 3 Pages
 
Ph 9620 3939  
 Fax 9620 3938 
 
First Name
Last Name
Company Name
Street Address
Address (cont.)
City &  State 
Post Code
Mobile Phone
Work Phone
ADSL Phone
E-mail

Office use only
Date Notified Installation
Date Notified Completion
   

ALL COSTS For Implementation

 

   Initial Setup Fee=$320 
     The once only minimum charge for initial installation.
   Monthly Rate = $220
   In Advance Debited from your credit card Monthly
    I have inspected the attached agreement terms 
    and acknowledge and agree that I will abide by 
    all conditions:-

Signed...........................................................          Date  :  

   

INITIAL TOTAL PAYMENT 
Setup
1st. Month
All prices include GST.      
GST component is $49.00
Initial
PAYMENT
Cheque
EFTPOS
VISA
MCARD
AMEX
 
BROADBAND WIRELESS
 INTERNET IMPLEMENTATION
This agreement covers all setup and installation of the ADSL Phone connection and Wireless hardware to enable a Business to connect to the Internet via ADSL for 12 Mths. Internet via ADSL for 12 Mths. ISP costs are included.

 Initial payment must be received before any installation or setup will be commenced.

  Whilst all care is taken by Wireless Capital, the customer assumes total responsibility for the goods at all times. Parts are covered under the warranty of the supplier. All Hardware related problems will be repaired free of charge during the contract period.  Wireless Capital and/or any personnel can not, nor will not, be held responsible for any perceived costs or loss, including loss of business, in the event of an operating fault or re-occurrence of the original, or any related, fault.

Ongoing Monthly Payments

 
Card Number
Expiry Date
Card Verify Last 3 digits on reverse.
Card Holder 
First Debit Date of Commencement
Last Debit Date of Last Payment
Monthly Amount   Including GST
Monthly
 payments by: 

VISA
MasterCard
AMEX
Diners

Customer Signature 
I have read & agree to all terms
 & Conditions and Authorise 
direct debit of my credit Card 
as supplied for the term of the 
contract with signature below..

 

......................................................