Please note: All dollar amounts are in Australian dollars and all transactions are processed in Australian dollars AUD$ NBN Application Form This form is for NBN (National Broadband Network) internet access. "*" indicates required fields Step 1 of 4 - Address 25% Enter the address where the NBN will be connectedStreet Address* Address Line 2 Suburb* Post Code* State*QLDNSWVICACTSAWATASNTBilling Address I would like my billing address to be different from the address above. Billing AddressStreet Address* Address Line 2 Suburb* Post Code* State*QLDNSWVICACTSAWATASNT Contact DetailsDetails entered here will become the authorised account holder.Your Name* First Name Last Name Date of Birth* DD slash MM slash YYYY Driver's Licence Number Card Number Driver's Licence State of IssueQLDNSWVICACTSAWATASNTContact Phone Number* Email* Company Name (If applicable) ABN / ACN (If applicable) Select Your Speed* 25Mbps/5Mbps - GoStreamer - $ 75.00/mth 50Mbps/20Mbps - GoInfinity - $ 89.00/mth 100mbps/20mbps - GoFortress - $99.00/mth 100Mbps/40Mbps - Go100/40 - $109.00/mth 250Mbps/25Mbps - Go250/25 - $119.00/mth 250Mbps/100Mbps - Go250/100 - $169.00/mth 500Mbps/200Mbps – Go500/200 - $289.00/mth 1000Mbps/50Mbps – Go1000/50 - $145.00/mth 1000Mbps/400Mbps – Go1000/400 - $379.00/mth Minimum ChargeLink to Critical Information SummaryLink to Critical Information SummaryLink to Critical Information SummaryLink to Critical Information SummaryGoPhone - Telephone Service* Yes No Need a Router/Modem?* Yes No Initial Upfront Payment PaymentAfter submitting this form, you will be required to contact our Customer Service Team on (07) 3632 8820 to have your credit card put on file for your order to progress further.Payment Authorisation* I authorise GoInternet Pty Ltd to debit my credit card for any invoice issued by GoInternet Pty Ltd. You will be charged for any once-off costs as well as a pro rata amount for the first month. You can change your payment details later by logging into your client account . Your ongoing monthly payment will be taken from your account at the time your invoices is generated.GoInternet Terms* I have read, understood and agree to abide by GoInternet's Policies. Link to Policies I.D. Verification Consent* I confirm that I am authorised to provide the personal details presented and I consent to my information being checked via Rapid ID for the purpose of confirming my identity. CAPTCHAInitial Upfront Payment