Consumer Customer Initial Setup Form

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Agreement
- I the undersigned have read and accept the BKB Internet terms and Conditions, Acceptable Use Policy and Spam Policy (located here)
- I have read and understood the information about BKB Internet's handling of information about me (personal information).
- I agree that by signing of this form, BKB Internet Pty Ltd is under no obligation to accept my application until they are satisfied that all of the information I have provided is true and correct.
Notice and Agreement to disclosure of your personal and credit information to a credit reporting agency. (Privacy Act 1998 as amended)
- I understand that BKB Internet is asking me for personal information about me so as to use Veda Advantage’s credit reporting service to credit check me. I understand that:
- Finally I agree to pay BKB Internet Pty Ltd the fees above as a part of this application and understand that a full refund will be made if this application is rejected.
I agree to these Terms and Conditions
Credit Card Authority
Full Name
Card Number
CVN
3 or 4 digit number on the back of the card
Expiry Date
Card Type
* 3% credit card surchange applies to American Express and Diners Club cards.
Recurrent charging authority
Name
FirstLast
Date
I authorise BKB Internet Pty Ltd to charge all service fees to my credit card in accordance with the Terms and Conditions until notified otherwise by me.

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