Application Form

Company Details

Company Name
Company Address
Suburb
State
Postcode
Postal Address
Suburb
State
Postcode

Primary Contact

Name
Position
Phone
Email
Fax No
Email(s) for Notifications
Internet Service Provider

Plan Details

No. of Backup Accounts required
File
Exchange
Mailbox
SQL
Other
No. of Backup Accounts required
Email Email Email Email Email
Email Email Email Email Email

Chosen Package

Up to 10GB ($55 per month) + initial setup fee
Up to 100GB ($110 per month) + initial setup fee
Up to 200GB ($165 per month) + initial setup fee
Up to 500GB ($220 per month) + initial setup fee
Up to 1 TB ($385 per month) + initial setup fee

Backup Retention Period

1 Year
3 Years
5 Years
Other

Preferred Login Details

Username
Password
Special Conditions

Accepted And Confirmed

I / We hereby authorise the above order and payments and accept the terms and conditions of the agreement attached.

Name
Signature
Date

Please Note: All prices are inclusive of GST.
Prices above are reliant on clients being connected to an ISP that does not charge for data uploads and/or
participates in the Western Australian Internet Exchange (WAIX). Please note Telstra is not a member of WAIX