Indigo Networks : Join Indigo

Join Indigo

Either fill out this online application form or print out THIS pdf file, fill it out and fax it to us.

Dial Up Application Form

* Fields marked with an asterisk must be fully completed.

UserName

Your username may be between 2 and 8 lower case letters or numbers (no spaces or fullstops). It is used for loggin in and as the prefix on your email address. A choice based on your name, business or nickname is recommended. (Please Write Clearly).
Preferred *	Second Preference

User Details

Title *

First Name *

Surname *

Company Name

ACN/BRN (If Applicable)

Address *

Suburb *

State *

Postcode *

Home Phone *

Work Phone

Fax No

How did you hear about Indigo

Refered By

Your Current Email Address (If you have one)

Operating System

Windows 98

Windows 95

Windows 3.1x

Windows NT4

Windows 2000

Macintosh

Unix

Other

Account Options

*	1 Off Connection Fee	Monthly *	Quarterly	Semi Annually	Annually
Bronze - Ultra low usage	$0!!	$16.50	$49.50	$99	$198
Silver - Low Usage	$0!!	$22	$60.50	$121	$220
Gold - Mid Usage	$0!!	$33	$91.30	$182.60	$330
Platinum - Standard Usage	$0!!	$44	$121	$240	$440
Diamond - Heavy Usage	$0!!	$66	$187	$374	$660
Ulti-Net - Unlimited Usage	$0!!	$29.95	$89.85	$179.70	$359.40

* Monthly Accounts occur a $5 administration charge per invoice unless paid by Direct Debit Credit Cards
# Pay as you surf Accounts must be paid by Direct Debit Credit Cards

Additional Services

	Second Email Address	Onsite Training	Home Installation	Indigo Approved Modem
Pricing	$66pa	$33 Per Hour	$38.50	$125

Payment Options

Cash

Cheque/Money Order

Mastercard

Visa

Bankcard

AMEX

Card No.
| | |

Full Name on Card

Please Direct debit from my credit card each time my account is due until further written notice.	Expiry Date /
Indigo sends all bills via E-mail. Please tick here for Postal billing