Sign Up Form

Thank you for your interest in QTelecom. We'll try to make this signup process easy as possible. This information required is to begin the process of getting you connected. A member of the Customer Care team will call you to further discuss your application. Let's get started:

Choose a Plan Required

As a start choose a plan and then complete all your personal information. We will confirm all your information prior to connecting any new service.

Select Phone Service Required

Transfer phone

Don't want to transfer phone

Need new connection

Need NBN Phone $11.00 p/mth plus calls

Please call me to discuss

Have you thought about bundling your phone service as well ?. We have some great value bundle options available. Choose from any of our Everyday Bundle plans.

I'm also interested in a Mobile Phone plan

Call me about including a Mobile service as well

We can have all your services on one bill - that includes your mobile service as well. Select this option and we can discuss the best plan for your current usage needs.

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Title Required

First name Required

Last name Required

Date of Birth Required

Drivers Licence Number Required

Email address Required

Daytime phone Required

Mobile phone Required

Service Phone Number

Service Address line 1

Service Address line 2

City / Town

Post code

State

Hardware required

Yes

Call me for more information

Payment Options

Direct Debit (We will advise direct debit details)

Pay upon Invoice

Other information

How did you find us ?

I'm an Existing Customer

From an Existing Customer

Word of Mouth

Paper advertising

Google

The applicant named hereby declares: Required

Confirmed

I am the applicant whose name appears on this Application. I am the lessee/authorised person of the telephone line which I am applying for ADSL or Phone service to be connected on. I have read, understood and agree to be bound by QTelecom’s Standard Terms & Conditions. I understand QTelecom may exchange information with a credit reporting agency, to obtain a consumer credit report about me, and/or to allow the credit reporting agency to create/maintain a credit information file containing information about me. All the information I have provided in this Application is true and correct. QTelecom will not use this information for any other purpose other than to get you connected to our network or services. Further information about this can be found on our website.

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Sign Up Form

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