Prospecting - Active Utilities

Before Proceeding to complete an application, please ensure you:

Are over 18
Have a valid Australian drivers licence, 18+ card OR Australian passport
Have a valid credit card OR Your bank details (Optional)

Are you an existing customer?

I am not an existing customer I am an existing customer and wish to add extra services to my account

Customer type

Residential Company

Site Code or address If unsure of site code please enter you street address and suburb only and select from available properties. If you are still not able to locate your building please contact our office on 1300 587 623 between 9am – 9pm 7 days a week and one of our staff will be happy to assist.

Enable Manual Entry

Lot Number

Floor Type

Number

Unit Type

Unit Number

Street Number

Suffix

Street

Street Type

Suffix

City / Suburb

State

Post Code

Do you require electricity?

No Yes

Note - Active does not offer Power at your premises. Please Click Next to Proceed

Note - Active does not offer Hot Water at your premises. Please Click Next to Proceed

Note - Active does not offer Heating, Ventilation and Air Conditioning at your premises. Please Click Next to Proceed

If no services are displayed please click next button to proceed with Telco services selection.

Do you require Telco services?

No Yes

Service type

Note - Active does not offer Telco Services at your premises. Please Click Next to Proceed

Please check your address before proceeding to ensure that the NBN is available at your home or business.

http://www.nbnco.com.au/connect-home-or-business/check-your-address.html

It appears that ADSL service is not available at your address. Do you want to confirm availability of one of our other telco services?

Data Pricing Details

Selected Product	Monthly Rate (incl. GST)

Voice Plan

Do you require a voice plan?

No Yes

Voice Pricing Details

Selected Product	Monthly Rate (incl. GST)

Do you have an existing phone service?

No Yes

Phone number to be ported

Current Service Provider

Account Number

Voice Service Porting Agreement

I confirm I am free of contract with my current provider and give authority for Activenet Pty Ltd to act on my behalf and port my number. I accept responsibility for any charges associated with the port of this service from the incumbent provider.

Public Directory Listing

As part of all Activenet voice services your name, address and telphone number will be published in the printed and online White Pages directories and also be made available from Directory assistance. Please select from one of the following options that best fits your needs.

Do you wish to be added to the public directory listing?

Yes No ($4.00 Inc GST silent number set up fee)

Additional Voice Services

Calling Number Display – Allows you to view the number of the incoming call if not private (Must have a compatible handset) - $2.95 Inc GST per month

Message Bank Service - $3.50 Inc Gst per month

Critical Information Summary

View the Critical information summary - for Data only Plans

View the Critical information summary - for Voice and Data Plans

I confirm I have read and understood the critical information summary for this service

Active Utilities do not currently offer any Telecommunications services at your site. Please click Next to continue with your application.

Items marked with * are mandatory

Your Details

*Title

*First Name

*Last Name

Phone

*Phone

*Mobile

Mobile

Fax

*Email

*Retype Email

*Date of Birth

Business Details

*Legal Business Name

*Trading As

ABN or ACN

ABN ACN Both

*ABN

*ACN

Supply Address

Unit

*Street Number

*Street

*Street Type

*City / Suburb

State*

*Post Code

*Connection Date

Billing Address

Is billing address different to Supply Address?

No Yes

Unit

*Street Number

*Street

*Street Type

*City / Suburb

*State

*Post Code

Medical Dependency

Medical / Life support equipment on site If yes is selected, then we will contact you to discuss further. Please note that a medical certificate to verify your claim is required.

No Yes

Authentication

Authentication type

18+ Card Drivers License Passport

Authentication state/country

Authentication number

Date of expiry

Delivery method

Email Mail ($3.30 Inc GST Monthly Fee) E-Mail & Mail ($3.30 Inc GST Monthly Fee)

Customer Type

Customer type

Real estate agent's company name

Agent's name

Agent's contact no.

Agent's email

Authorised representative

Would you like to delegate an authorised representative?

No Yes

Title

First Name

Last Name

Mobile

Date of birth

Terms and Conditions

By submitting this Application to Us, You acknowledge that you have had an opportunity to read and otherwise agree to be bound by the Active Utilities Terms and Conditions and that Our Agreement with You for the provision of Services incorporates this Application, the relevant sections of the Active Utilities Terms and Conditions (as applicable) and the Active Utilities Fee Schedule/s (as applicable) all as varied and amended from time to time.

You further acknowledge that You are under no obligation to purchase utilities from Us, but have elected to do so by submitting this Application rather than choose to purchase the utilities described in this Application from a licensed retailer. You agree and acknowledge that may We act in the limited capacity as agent for your Building Manager or Owner/Operator in relation to any Services We provide to You.

Customer Terms and Privacy Policy

Active Utilities Fee Schedule

Service plan summary

Unable to display details at the moment.

Service Acceptance

I confirm that I have read and agree to all the terms and conditions of the service and listed pricing and wish to proceed with this order.

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Utilities

Are you an existing customer?

Electricity Plans

Telco

Data Plans

Voice Plan

Voice Service Porting Agreement

Public Directory Listing

Additional Voice Services

Critical Information Summary

Personal Details

Your Details

Business Details

Supply Address

Billing Address

Medical Dependency

Authentication

Authentication

Delivery method

Customer Type

Authorised representative

Summary

Terms and Conditions

Service plan summary

Service Acceptance

Utilities

Are you an existing customer?

Electricity Plans

Telco

Data Plans

Voice Plan

Voice Service Porting Agreement

Public Directory Listing

Additional Voice Services

Critical Information Summary

Personal Details

Your Details

Business Details

Supply Address

Billing Address

Medical Dependency

Authentication

Authentication

Delivery method

Customer Type

Authorised representative

Summary

Terms and Conditions

Service plan summary

Service Acceptance

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