RETURN THIS FORM BY: Fax (02) 9850 0813 or post Customer Service, TPG, 65 Waterloo Rd, North
Ryde, NSW 2113
Enquiries 1300 360 855
Direct Debit Authorisation
Agreement with TPG Internet Pty Ltd (ABN 15 068 383 737) This Direct Debit Authorisation (DD Authorisation) and Service C Your Username Once you have registered for TPG Broadband, we will send you Agreement is issued by TPG Internet Pty Ltd. (User ID 142619) your username via email, which you should then enter here. The Service Agreement and the DD Authorisation contain the terms and conditions on which you authorise TPG Internet to debit money from Username your account and the obligations of TPG Internet and you under this agreement. You should read through the Service Agreement carefully to ensure you understand these terms and conditions before signing D Contact Details the DD Authorisation. First Name A Direct Debit Service Agreement 1. Our commitment to you We will not change the amount or frequency of drawing arrangements without your prior approval. TPG Internet will not disclose your details except where necessary to TPG Internets financial institution and for the purposes of conducting direct debits with your financial institution. TPG Internet will give you at least 14 days notice in writing if there are changes to the terms of the drawing arrangements. TPG Internet will draw from your nominated financial institution account on the business day normally 7 days prior to the expiry of your current internet accounts subscription period. If the due drawing date is not a business day, TPG Internet will draw on the business day before or after that date. 2. Your commitment to us It is your responsibility to: Ensure your nominated account can accept direct debits. Ensure there are sufficient funds available in the nominated account to meet each drawing on the due date. Advise us if the nominated account is transferred or closed, or the account details change. Arrange an alternative payment method acceptable to TPG Internet if TPG Internet cancels the drawing arrangements. Ensure that all account holders on the nominated financial institution account sign the Direct Debit Authorisation. A fee of $50 applies if the financial institution rejects a Direct Debit transaction. If you choose to cancel your Direct Debit payment, please contact TPG Customer Service in order to arrange Credit Card payment. 3. Your rights You should contact TPG Internet if you wish to alter the drawing arrangements. This includes: stopping an individual drawing altering the DD Authorisation cancelling the DD Authorisation Where you consider that a drawing has been initiated incorrectly, you should firstly contact TPG Customer Service on the number appearing above. If you are not satisfied with the response, please write to us. Your letter should be marked Notice of Complaint and addressed to: TPG Internet at the address appearing above. TPG Internet will respond within 7 days of receiving your letter. TPG Internet has formal procedures for dealing with a complaint. 4. Other information TPG Internet reserves the right to cancel drawing arrangements if drawings are dishonoured by your financial institution. Your drawing arrangements are also governed by the terms and conditions of your TPG Internet account. Surname Address Suburb State Phone Email E Direct Debit Payment Details Please provide details of the account you wish to debit. I/We request TPG Internet Pty Ltd (ABN 15 068 383 737) to draw money from my/our account conducted with: BSB Number Account Number Name of Financial Institution Branch Accountholders Name(s) F Agreement and Authorisation I/We declare that I/We have read, understood and agree to abide by the terms of the Direct Debit Service Agreement and Terms and Conditions of my/our TPG Internet account, and verify that I/We are over 18 years of age and able to enter into legally binding contracts. Signature Full Name Title Date Signature Full Name Title Date Post Code
B ADSL Location Number Please supply the phone number of the phone line you want ADSL to be installed on. Phone No.
Date of issue: 23/08/06. Replaces: 20/06/06. Page1 of 1
