Fill out and Print this form, sign and fax to: 02 6353 1718

LiSP

ABN 84 071 617 966

LiSP Pty Ltd
INTERNET ACCESS APPLICATION FORM
Lithgow/Blue Mountains
LiSP Pty Ltd. PO Box 114, Lithgow NSW 2790.
Phone: 02 6352 1752 Fax: 02 6353 1718

TITLE:

NAME:

SURNAME:

BUSINESS NAME:

EMAIL:

ADDRESS:

TOWN:

POSTCODE:

DRIVERS LICENCE: PHONE: FAX:

USERNAME (2-8 characters , a-z, 0-9)

PASSWORD (2-8 characters , a-z, 0-9)

COMPUTER TYPE eg; (MAC, IBM)

OPERATING SYSTEM

L.i.S.P SERVICES (Please indicate your preferences with a )
Onsite Connection fee (one off fee).

$44

Setup and tutorial fee payable to the individual doing the installation. This is separate from the Account Creation fee below.

Account Creation fee - LiSP Lithgow setup program - 782k

$11

This is for the creation of your Internet access account and E-mail address.
OUR INTERNET ACCESS PLANS ARE AS FOLLOWS: Web space: - first 10 meg free with an appropriate access plan. Please

MONTHLY PLANS * Use them or lose them. $2.20 per hour for excess hours

Unlimited Premium

$49.50 per month

Unlimited Standard

$24.75 per month

200 hours *

$44.00 per month

150 hours *

$38.50 per month

75 hours *

$33.00 per month

25 hours *

$22.00 per month

10 hours *

$11.00 per month
WIRELESS BROADBAND * additional blocks of 1.5GB $17.50 each
First 1.5 GB $38.50 per month

CASUAL PLANS: NOTE: Must be used within 6 months!

50 hours **

$77.00

75 hours **

$110.00

100 hours **

$132.00

150 hours **

$165.00

MONTHLY - ADSL - (all you can eat)

Please use the ADSL Application Form

Download Acrobat Reader HERE

MONTHLY - SATELLITE - (Excess Data $0.11 per/MB)

256k access

$33.00 / 500MB data

256k access

$44.00 / 1 GIG data

256k access

$66.00 / 2 GIG data

400k access

$55.00 / 1 GIG data

400k access

$77.00 / 2 GIG data

MONTHLY - DOV - (Excess Data $0.22 per/mb)
DOV is provided free of charge on all modem dial access plans. Requires a Data Over Voice Modem, Telstra Onramp Home Highway to take advantage of low cost calls. Inquire for modem details, cost and list of preferred suppliers. 64k DOV is equivalent to an 80k modem connection.

All plans are to be PREPAID. Credit Cards are preferred, however, cash and cheque/money order will be accepted as long as they are promptly paid. We will accept multiple months in advance. (All rates are inclusive of GST. To calculate the GST divide the amount by 11). Prices are subject to change without notice.

Paying by: cash cheque money order AMOUNT: $

Paying by: Credit Card AMOUNT: $
Card Number:
Name on card:

Card Type: Bankcard Visa Mastercard
Expire Date:
Signature:

Although we are very helpful people, please understand LiSP Pty Ltd is only a provider of Internet Access. We can't be responsible for your software updating and maintenance of your computer. There are many local computer businesses that can give you assistance with computer problems. There is an enormous amount of on-line help to be gained from the Internet and our "Dr LiSP".
I am 18years and over and I have read the "Conditions of Use - LiSP Pty Ltd" and agree to the terms and conditions therein.
Signature Date