SECTION 1: INSTALLATION CONFIRMATION

Customer/Contact Name: ___________________________________________

Business Name (if applicable): ___________________________________

Installation date: ________/________/_______________

Time ________ am/pm

Installation address: ____________________________________________

_____________________________________Post code: __________________

	1. I have read and understood the Telstra BigPond 
broadband terms and conditions, the Acceptable Use Policy and the 
Rate Card.

	2. I accept your offer to install Telstra BigPond 
broadband on the terms and conditions set out in the Telstra 
BigPond broadband terms and conditions, the agreement to be 
effective from the earlier of the delivery of the modem or 
delivery of the Telstra BigPond Broadband installation kit.

	3. I agree that I will be bound by the Telstra BigPond 
broadband terms and conditions when delivery of either the modem 
or the Telstra BigPond Broadband installation kit occurs you 
first commence installing the Telstra BigPond broadband.

	4. I declare that all information I have given you is 
accurate and not misleading and I am aware that you are relying 
on it. 

Signature:  ____________________________________________________

		SECTION 2:  INSTALLATION

Option A: ___ (tick) I will be present when you install the 
Telstra BigPond broadband Internet service.

OR

Option B: ___ (tick) I nominate _________________________________
as my agent to give you access to the premises described above 
so that you can install the Telstra BigPond broadband Internet 
service.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
		SECTION 3: TELSTRA USE ONLY

Account number: _________________________Installer ID: __________