Fusion Bonding Order Form

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Customer Details
Company Name :
First Name :
Last Name :
Email Address :
Phone Number :
ABN# :
Address1 :
Address2 :
City :
State :
Postcode :
Site Address    As Above
Company Name :
First Name :
Last Name :
Email Address :
Phone Number :
ABN# :
Address1 :
Address2 :
City :
State :
Postcode :
Fusion Plan Selection

A: Select the plan
Item Monthly fee Desscription Total
Fusion Bonding plan 250 $0.00 Fusion Bonding plan with up to 250 GB of bonded data.
Fusion Bonding plan 500 $60.00 Fusion Bonding plan with up to 500 GB of bonded data.

B: Select the Bonding platform for the site
Item Set Up fee Description platform selection( Desk top or Rack mount) Total
Fusion Set up fee and Bonding platform 24 month contract $550.00
Fusion Set up fee and Bonding platform 12 month contract $650.00

C: Select the number of lines to bond and any additional options
Item Monthly feee Description Total
Number of lines to bond $85.00 Select the number of lines to Bond or additional lines
Data Compression. $0.00 Activates Fusion Data compression for enhanced throughput.
Traffic Shaping $0.00 Provides priority for interactive traffic e.g. VOIP, Video etc.
Link Authentication. $10.00 Forces tunnel authentication, for high security sensitive applications and connections.
3G fail over Connection. $60.00 An additional connection for 3G fail over. Requires 3G router / modem ( Not USB)
Plan Upgrade 250GB ->500GB $50.00 Increase bonded data allowance for existing 250GB plans
 
  Set up
  Monthly reoccurring
  GST (@10%)
  Total
 
Terms and Conditions - summary
Your signature indicates your agreement to these terms and conditions.
• Our Standard Form of Agreement Conditions of service and our fee structure.
• Fusion will endeavour to ship to the customer or their agent a bonding system within 21 days of order.
• Payment will be made within 14 days if on a business invoice or a late payment interest fee will apply, charged per month.
• Excess data will be charged at $1.00 GB with a maximum fee of $300.00
• Customer details are only kept to enable support and configuration management.
• I understand I am responsible for all broadband charges incurred on this service, and the devices supplied under this agreement remains the property of Fusion Broadband Pty Ltd, and that if I do not return them within 15 days of the end of this agreement I will be charged for the system at replacement retail cost. I hereby agree to the Fusion broadband standard terms and conditions published at w ww.fusionbroadband.com.au and authorise Fusion Broadband to debit the credit card registered with Fusion Broadband Pty Ltd via the Fusion customer portal. If I have elected to pay via invoice or direct bank deposit I agree payment will occur within 7 days of the date the invoice was issued.
• Fusion Broadband reserves the right to suspend the customers bonding service or access for payment failure. Should the service be cancelled for payment failure, within 15 days of the cancellation notification the Fusion Broadband CPE system will be returned to Fusion Broadband in working order and undamaged condition. If unit (s) are not returned or returned damaged or not in working order you will be charged for the system at replacement retail cost.
• Should you wish to cancel this account, you may do so with 30 days notice. Within this 30 days the Fusion Broadband CPE system will be returned to Fusion Broadband in working order and undamaged condition. If units are not returned or returned damaged or not in working order you will be charged
Authorised Signature:
Authorised Name:   Date           /          /          
 
internal use only
ICT Service Request: Order enter Date :
ICT Dealer Code: Ship date:
Fusion Order #: Service Active Date:
Bonded Service FNN FNN 1: FNN 2: FNN 3:
  FNN 4: FNN 5: FNN 6:
       
Fusion Broadband Pty Ltd. ABN:18149550541 Service order form 01/02/2012 Copyright 2012.