IT&T Information Technology and Telecommunications Wollongong

Residential Application Form

 Drivers license Occupation details Passport details

I authorise the request for contact by an authorised representative on my behalf. I warrant that all information in this application is true and correct. If I am an individual applicant I consent under the Privacy Act 1988 (Cth), to the access, use and disclosure of information by and to Telstra under clause 4 overleaf and in any other circumstances not prohibited by the Act. I warrant that I am your customer in respect of the services. I hereby authorise you to disclose information relating to me to the Dealer / Vendor regarding the services on this application form and include my name on commission payment reconciliation advices that you send to the Dealer. If the Customer is a company, the signatory hereby warrants that he/she is duly authorised to sign this application on behalf of the Customer.

Terms & Conditions

  1. I hereby confirm that I wish to be supplied with the Telstra Services described in this application and acknowledge that the Service/s will be provided subject to the provisions of Telstras Standard Form of Agreement formulated by Telstra for the purposes of Part 23 of the Telecommunications Act 1997 as varied by Telstra from time to time. Copies of Telstras Standard Form of Agreement are available at all Telstra Business centres.
  2. I understand that Telstra reserves the right to disconnect equipment which is unsafe or which causes interference to other public network users. I agree to abide by the requirements set out on this form.
  3. The Dealer identified on the front of this form is a Telstra Approved Dealer and is acting as agent for Telstra for the sole purpose of receiving this Application from you and processing the Application in accordance with its Agreement with Telstra. The Dealer is not acting nor does it purport to act as your agent for your Application for services from Telstra or for anything contemplated by your application to Telstra.
  4. Personal or Sole Trader, Partnership and Unincorporated Association Applications Privacy Act 1988 (CTH) - Consent to access, use of and disclosure of information by and to Telstra. Telstra informs me (in accordance with section 18E(8)(c) of the Privacy Act 1988 (the Act)), and I hereby declare and acknowledge that items of personal information about me (including information in an application and information arising from the conduct of an account) and permit to be kept on a credit information file, may be disclosed to a credit reporting agency. I irrevocably and specifically agree: (a) for the purpose of section 18(L)(4) of the Act, that Telstra may use information of the kind referred to in that section (including information that concerns my commercial activities or commercial credit worthiness for the purpose of assessing an application; (b) for the purpose of section 18K(1)(b) and 18(1)(h) of the Act, that a credit reporting agency may disclose personal information from my credit information file/s to Telstra for the purpose of assessing an application for commercial credit by me and for the purpose of the collection of payments that are overdue in respect of any commercial credit provided by Telstra and (c) for the purpose of section 18(1)(b) of the Act that Telstra may give to and seek from another credit provider, any information derived from a report or the entire report fro any one or more of the following purposes (i) to assess an application, my credit worthiness and/or the Applicants continuing credit worthiness and (ii) to notify, exchange and/or obtain information with other credit providers in relation to the conduct or status of, or a default in relation to, any account(s) held by me with them or Telstra.

 Yes No