Westnet Broadband1 Application Form
(a) Existing Westnet Members
(b) New Westnet Customers
Business Name (if applicable)
Suburb / Town
Day Time Phone Number
After Hours Phone Number
Mobile Phone Number
Correspondence Email Address
Your username will form the first part of your email address
(firstname.lastname@example.org). If you would prefer all correspondence from Westnet to
be delivered to a different email address from the one which will be created, please
write that email address you would like to use in the box provided.
Would you like to be notified by fax when Westnet receives your application?
Westnet Pty Ltd ABN: 50 086 416 908
Level 7, 152 St George’s Tce, Perth, 6000
GPO Box C121 Perth 6839
1300 792 566
1300 786 068
• This application form allows for the installation of a Broadband1 service on an active standard telephone line only. If you do not have an active telephone line, you may arrange a
New Phone Connection by contacting Westnet Sales on 1300 792 566.
• Completion for an Broadband1 application takes on average between two (2) to ten (10) working days. Delays may occur if an infrastructure upgrade is required on your line / exchange.
• Westnet Broadband customers are required to provide credit card or direct debit details for automatic monthly debit.
• Business customers may choose to Guarantor (link) a new application to an existing account for billing purposes. To do this, a business letterhead must be attached to this application.
• Failure to fill out the form correctly may result in delays.
• For any queries, please contact Westnet Sales on 1300 792 566 or email@example.com.
Date of Birth - (DD/MM/YYYY)
Preferred Username (must be between 4 and 20 characters)
Alternate Username (used if your preferred username is taken)
Password (please take note of your p