Order Form

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RESIDENTIAL ADSL CONNECTION ORDER FORM IMPORTANT INFORMATION – PLEASE READ CAREFULLY Customer Account Name: (Name that Account will be held in) UBT Customer Code: (Alpha-numeric Code) Telco Account No:

If Known (4/6 Digit Code as per Phone Account)

Contact Name: (Name of person completing and signing the Terms & Conditions of Sale - below) Street Address:

Town /City


Post Code

Billing Address:

Town /City (if different)


Post Code

Phone Number

Fax Number

E-Mail Address:

ADSL Connection Details It is a requirement of this product that at least one residential phone number is with UBT IT&T. If you have no phone lines with UBT IT&T please refer to Section 2 of this form to transfer a line for this purpose. Phone number to have ADSL activated on: (


Once off connection fee

$110 (compulsory)

Select Plan

Medium 1.5 Mbps ADSL1, 5Gb Data - $44.00/month Medium 1.5 Mbps ADSL1, 15Gb Data - $55.00/month Fast ADSL2+, 50Gb Data - $77.00/month* Fast ADSL2+, 100Gb Data - $88.00/month*

Modem required

None - $0 Wireless (4 ports+) - $165.00

Direct debit form to be completed see attached * All prices quoted are GST inclusive. *Where an ADSL2+ Service is unavailable and 8Mbps service will be provisioned.


Direct Debit Request Request and Authority to debit the account named below to pay UBT IT&T UBT Account Number: Company Name: ABN: Authorised Person Name: Position in company: Request and Authority to debit

Surname or company name Given names or ACN/ARBN institution, for any amount UBT may debit or charge you to be debited through the Bulk Electronic Clearing terms and conditions of the Direct Debit Request Service Agreement and any further instructions provided below.

Insert the name and address of

Financial institution name

is held


Insert details of Bank Account

Name of account holder BSB number Account number

Or Credit Card to be debited

Credit Card Type





Credit Card No Name on Card Acknowledgment

By signing this Direct Debit Request you acknowledge having read and understood the terms and conditions governing the debit arrangements between you and UBT as set out in this Request and in your Direct Debit Request Service Agreement.

Payment Details

Debits may be made fourteen days after the issue of a billing advice.

Insert your signature and address


(If signing for a company, sign and print full name and capacity for signing e.g. Director) Address Date

Does UBT IT&T provide Australia Wide ADSL2+ coverage?

Can I use the phone and the internet at the same time?

Yes UBT IT&T provides ADSL2+ Australia Wide. ADSL2+ is available on exchanges right across Australia subject to coverage in your area.

Yes you can use the internet at the same time, as your telephone calls are run over the analogue PSTN network and your ADSL2+ broadband is delivered via a digital signal.

How does ADSL2+ work? ADSL2+ works the same as your existing ADSL service. It operates over your existing telephone line. The signal is transmitted via your telephone line using a digital signal. Your existing telephone / fax works on an analogue signal, the same time.

What hardware do I need to get ADSL2+? Should you be an existing NOA / OFG ADSL user your current Netcomm NOA / OFG ADSL customer we can supply one to you at a cost of $130 How reliable is UBT IT&T ADSL2+? UBT IT&T ADSL2+ has a target service level of 99.1% uptime which is often maintained above this level.

Phone 1300 010 102 Option 1 | Fax 1300 306 161 | email: [email protected]