New Customer Application Form

Join with Peninsula Telecom, please complete our New Customer Application Form. This can be completed online via the webform or download a pdf version and email to admin@penintel.com.au

New Customer Application Form

This form takes approximteely 5-10mins to complete. Please have your personal, company and preferred payment details ready.

Company Name

Trading Name

ABN

ACN

Phone

Account Type

Street Address

Address 1

Address 2

City/Suburb

State

Postcode

Billing address

Same as street address

Address 1

Address 2

City/Suburb

State

Postcode

Contact person details

Title

Given Name(s)

Surname

Position

Phone number (bh)

Phone number (ah)

Mobile

Fax

Alternate email

Payment Method

Account Name

Bank Name

Account Number

BSB

Card Type

Card Number

Card CCV

Card Expiry

I authorise Peninsula Telecom {36 141 459 574} to charge the account nominated. *

I acknowledge a surcharge of 1.5% will be applied to payments made using VISA and Mastercard, and 2.5% for payments using American Express (AMEX). *

Signature Name

Signature Position

I have read and understood Peninsula Telecom’s (36 141 459 574) Standard Form of Agreement and agree to the terms and conditions. I understand that all bills are delivered by email delivery and that Direct Debit from either a bank account or credit card is required. *

View our full terms and conditions here.

New Customer Application Form

Join with Peninsula Telecom, please complete our New Customer Application Form. This can be completed online via the webform or download a pdf version and email to admin@penintel.com.au

New Customer Application Form

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