NBN Customer Authority Form

 

Customer authorisation form For Telecommunication Services and Direct Debit Facility.
Please complete all sections in CAPITAL LETTERS, sign and return to us via email to info@v4.net.au, fax to 03 8612 4922 and 03 9826 6832 or
post to PO BOX 6045, South Yarra VIC 3141.

SECTION 1 - SERVICE DETAILS

Monthly fee X Remaining Month (24 Month Contract Term)

SECTION 2 - ACCOUNT DETAILS


SECTION 3 - ADDRESS DETAILS


SECTION 4 - AUTHORISED CONTACT DETAILS


SECTION 5 - INVOICE METHOD


SECTION 6 - PAYMENT DETAILS

BANK ACCOUNT DETAILS (OR FINANCIAL INSTITUTION):

Or

CREDIT CARD DETAILS


SECTION 7 -Office Use Only


SECTION 8 - Direct Debit terms and conditions

This Direct Debit Request (DDR) Service Agreement sets out the terms on which we will debit (withdraw) regular payments directly from your nominated bank account or credit card to pay for the service we provide to you. In this DDR Service Agreement, references to "you" are references to the person whose name appears under "Account Holder Details". References to "We" and "us" are references to V4 Telecom Pty Ltd. V4 Telecom Pty Ltd’s commitment to you: Payment Arrangements

  1. If you have selected automatic Direct Debit, we will advise you, in the form of an invoice, of the details of the amount and due date of each direct debit payment at least 14 calender days prior to debiting that amount from your nominated bank account or credit card.
  2. We will debit your nominated bank account or credit card by the amount due on the due date or if the due date is not a business day, the first business day following the due date.
  3. We will debit the entire amount stated as being due on the invoice.
  4. We will not change the frequency of your direct debit payment arrangement without your prior approval.
  5. Payments will be debited from your nominated bank account or credit card until your V4 Telecom Pty Ltd account is terminated and all charges are paid or until your direct debit arrangement is cancelled.
  6. Direct Debit: Under the Direct Debit System (BECS) is not available on all accounts. You are advised to check your account details with your Financial institution before completing the Direct Debit Request Form.
  7. Ping On establishment or modification of your direct debit bank account arrangement, we may immediately initiate a credit to your nominated bank account (your “ping”) to test the arrangement.
  8. On establishment or modification of your direct debit credit card arrangement, we may immediately initiate a pre-authorisation debit payment of $1 on your credit card to test the arrangement. This payment will not change the balance of your credit card, but may reserve $1 against your credit card limit.
  9. Cancellation or Variation of Payment Arrangements: You may cancel or vary your direct debit arrangement at any time by: Calling us on 1300 843 130 at least 3 days prior to the payment date or by giving 14 days prior written notice to us at V4 Telecom Pty Ltd, PO Box 6045, South Yarra Victoria, 3141. If payment is due within the 14 days notice period, V4 Telecom Pty Ltd may still debit your account for any outstanding amounts.
  10. If you want to dispute a direct debit payment that has been debited from your nominated bank account or credit card, you need to call us on 1300 843 130 or write to us providing particulars at V4 Telecom Pty Ltd, PO Box 6045, South Yarra, Victoria 3141.
  11. We reserve the right to cancel your direct debit arrangement if two or more direct debit payments are rejected by your nominated Financial Institution and to arrange with you an alternative payment method.
  12. It is your responsibility to arrange an alternative payment method with us if your direct debit arrangement is cancelled either by you or your nominated Financial Institution.
  13. Privacy: We collect personal information about you (including information about your credit record) to assess your application and, if it is approved, provide services to you. We may disclose your personal information to other telecommunications service and equipment providers, resellers, credit providers, credit reporting agencies and organisations who provide outsourced services to us. If required, we may provide your account details to our Financial Institution. If you do not provide us with this information, we may be unable to assess your application or provide services to you. We may also use your personal information to provide you with details of related products and services or to conduct research analysis. To do that, we may disclose information to our related bodies corporate and our business partners and associates. We will not rent, trade or sell your personal information to list renters. In most cases, you will be able to access our Privacy Policy at www.v4.net.au or you may receive a hard copy by calling us on 1300 843 130.
  14. Your Commitment to us: It is your responsibility to ensure that sufficient funds are available in your nominated bank account or credit card to meet a direct debit payment on its due date.
  15. It is your responsibility to advise us of any changes to any of the direct debit payment details provided on this form.
  16. If you have insufficient funds or a direct debit payment is rejected then we will charge you a dishonour fee for the rejected transaction of $11.
  17. If you are not registered to receive your invoice via email then a $4.99 fee will be charged to send you a paper invoice.
  18. If your account is suspended for non-payment then a $33 suspension fee will be charged per instance. Un-suspending the account will not attract any charges.
  19. GST is excluded from all charges unless expressly outlined.
  20. Account Ownership: You acknowledge that you are an authorised signatory to your nominated bank account or credit card and have authority to establish direct debit arrangements on that account or credit card.

SECTION 9 -Terms & Conditions

Please read the following conditions before signing the declaration below:

  • I am authorised to sign this form and declare that every piece of information given on this form is true and correct.
  • I understand that all references to “V4 Telecom” on this form are to V4 Telecom Pty Ltd.
  • I understand and accept complete responsibility and financial liability for all telecommunications charges billed by V4 Telecom, and accept that credit checks may be undertaken.
  • I agree that the first bill will also have any charges from the day I signed up as a pro-rated charge. Therefore whilst my first bill may look higher – it is accurate and the charges are from the day my service was moved across to V4 Telecom.
  • I agree that the first bill will also have any charges from the day I signed up as a pro-rated charge. Therefore whilst my first bill may look higher – it is accurate and the charges are from the day my service was moved across to V4 Telecom.
  • I understand that the penalty for early cancellation on all V4 Telecom Service Plans requires a once-off payment of $200 as the Cancellation Fee per Service Plan and must be made within 14 days from date of cancellation.
  • I also agree that if V4 Telecom accepts this application, that services will be provided in accordance with V4 Telecom's Standard Forms Of Agreements (SFOA) and also V4 Telecom's Terms & Conditions ( T & Cs ), a full version of the T & Cs is available for viewing on www.v4.net.au
  • If transferring my mobile service number to V4 Telecom, I understand this may result in any higher level services or features (e.g. Voicemail ) being deactivated or terminated.
  • I understand that if I have an existing contract with my current service provider, there may be costs and obligations associated with my existing number(s) and the transfer of my services. This may result in having to pay an early termination amount.
  • I understand that by signing this application or any other form of agreement with V4 Telecom, I consent to be contacted for marketing services related to Telecommunications products and services.

SECTION 10 - SERVICE AGREEMENT

(Monthly fee X Contract Term (24M only) Cancellation fee is applicable upon breach of Contract).

For all the terms and conditions of your direct debit arrangement with us, please read the Direct Debit Request Service Agreement.

Our commitment to you:

  • You will have up to 14 days to pay your bill.
  • Your bill will clearly tell you the amount you owe us and when this needs to be paid.
  • We don't expect you to pay charges that are in dispute until they're resolved.
  • We won't change the frequency of your direct payments without your permission.

Your commitment to us:

  • You will make sure there are sufficient funds in your account to meet your direct debit payments.
  • If any of the details about your nominated bank account or credit card changes you'll let us know so that your direct debit can be updated.
  • If a direct debit payment is rejected by your bank or financial institution, a dishonour fee will be charged. Your bank may also charge you a fee.

Cancelling or varying payments:

  • You can cancel or change your direct debit at any time. This can be done by calling us or writing to us. If you choose to cancel your direct debit you will be charged an administration fee each month to cover processing your cash or cheque

Changes to the agreement:

  • We can make changes to our Direct Debit Request Service Agreement at any time by giving you 14 days prior notice.

SECTION 11 - Acknowledgment

I declare I have read and understood the above conditions and I authorise the services listed on this form to be provisioned with V4 Telecom. I authorise you to take money due to V4 Telecom Pty Ltd out of my nominated account (if provided) on the terms shown on this form and according to the Direct Debit Request Service Agreement and pay it to V4 Telecom Pty Ltd. Person signing this form is personally liable if they are not an authorised signatory for the company listed on this form applying for the services.


Or DOWNLOAD NBN CUSTOMER AUTHORISATION & DIRECT DEBIT FORM