Ice Communications
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Ice Communications
Network Card Account Number
   
Legal Entity (as per ACN/ARBN)
 ACN/ARBN
 ABN *
Trading As (if applicable)
 Years Trading
Contact Name *
 Position
Unit
 Street Number & Name *
 Suburb *
 State *
 Postcode *

Billing Address (If Different to above)
Unit
 Street Number & Name
 Suburb
 State
 Postcode
Telephone *
 Facsimile
 Mobile
Email *

Ice Communications
Post Bill      Email Bill      Itemised Bill      Direct Debit

Ice Communications
Service Options
ISDN Services: Yes No ISDN Number Range
SERVICE INFORMATION

Please complete a separate list of service numbers including a signature at the bottom of each page if further space required.
Service Number Department (optional)
Inbound Service Number Answer point Department (optional)

Ice Communications
Select number of mobile phone numbers you wish to apply for

1 Select Option:
 New Number or Port Number?
 Monthly Contract
Handset Model
 Outright or Monthly Payments?
To be completed only if porting an existing mobile number
Mobile Number
 Current Mobile Service Provider
 Current Mobile Account Number
 Preferred Port Date

 
Ice Communications
I want to Existing Provider Name

Telephone number you would like to connect the Internet service to (including area code)

Please do not apply for a broadband service using a telephone number that already has an existing broadband service attached to it unless you want to transfer (‘fast churn’) the existing service.
Fast churn activation is not available from all providers.

Please choose your plan and modem (broadband requires a modem which can be purchased with your connection and is yours to keep).
    

Ice Communications
    

If transferring existing modem please provide UTID


Ice Communications
Apply for Dial-up

Ice Communications
You may have up to 5 email addresses on your service. Please specify the email address/es you would like to apply for.
@ icemail.com.au
@ icemail.com.au
@ icemail.com.au
@ icemail.com.au
@ icemail.com.au

Ice Communications
Web Hosting

Existing Domain Name
 Current Registar
Registry Key


 Features: MySQL CGI PHP SSL
Domain Registration (to be completed only if you are applying for a new domain name)
Required Domain Name*
www. .




By submitting this applications you are responsible for payment of this account.






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