1.Customer Information

Name:

Address:

Email:

Phone:

Preferred date & time:

Do you have an active phone line?

YesNo

2. Current service provider Information

VodafoneSpark2DegreesOther

3. Additional services

I have my own router and/or TV Box.don’t have my own router or TV Box and would like to use yours.*

*Warner telecommunication can provide a router and/or TV Box for you for additional refundable deposit. Actual height of deposit varies according to the router and/or TV Box. Tick this box if you want router added to your order. Additional shipping costs $10 in total will apply and are non-refundable.

4. Family Plan

Please select your plan:

Payment:Monthly prepaidYearly prepaid

*We charge $99 initial fee for monthly prepaid services

5.Do you need a on site service? (Auckland only)

Yes((service charge $150+gst)No