Star Telecom - Service Transfer Form

Customer Information

Are you a new or existing customer? *

Existing Customer Details

Account Name *

Contact Full Name *

Second Contact Full Name

Contact Number

Email Address

New Customer Details

Company Name *

ABN / ACN *

Contact Full Name *

Driver's Licence Number *

Date of Birth *

Email Address

Contact Number *

Address Information

Service Address *

Is the billing address different?

Service List

Service Provider	Service No.	Charge (Ex-GST)	Description	Contract Term	Provider / Acc No.

Services Summary

Subtotal (Ex-GST) $0.00

GST (10%) $0.00

Total (Inc-GST) $0.00

Device Requirements

Do you need new devices? *

Device Name	Charge (Ex-GST)	Description

Devices Summary

Subtotal (Ex-GST) $0.00

GST (10%) $0.00

Total (Inc-GST) $0.00

Additional Notes

Special Requirements or Additional Information

Supporting Documents

Click to upload supporting document

(PDF, DOC, JPG, PNG)

Signature

I confirm the above information is true and authorize the transfer. *