Fixed Wireless Signup Form Select your planLength of Contract12 Months24 Months36 MonthsSelect your Plan Installation addressInstallation address* Your DetailsEmail Name* First Last D.O.B.* DD slash MM slash YYYY Phone*Acceptance of Terms* I have read and accept the Terms and Conditions Verify Payment DetailsPlease call me for my Credit Card Details Please call me for my Credit Card Details We will only debit your credit card or bank account for internet services after your service has been commissioned successfully. Until such time no charges will be made for services supplied. If you have ordered equipment we will debit your account at time of postage prior to the installation. Credit Card MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Process and Submit HiddenCardProcessed CardSuccess HiddenSimplifyToken Our website is secure and PCI compliant. We do not hold your credit card information, it connects directly to our Commonwealth Bank BPoint Data Vault.