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Company Details

 
Company * Email *
Address 1 * Address 2
Suburb * State * Postcode *
Phone Number (Work) * Fax Number
ABN
 
Authorised Contact Details
First Name * Last Name *
Mobile Number * Email *
Order Details
Number of Accounts
Order with Modems Yes    No
Programming of new Modem required Yes    No
(If Yes, an applicable cost of $15 per modem is incurred)
maXwan Activation Date
* Activation date must be within one week from payment date.

 
Subnet Allocation for consecutive IP addresses 32 host - $40
* One off fee 128 host - $80
  512 host - $120
  Random IP(s)
Number of Accounts   
maXvpn Activation Date  
* Activation date must be within one week from payment date.

 
Static IP Yes    No
* $60 per year
Payment Details
Credit Card Payment        Direct Debt Payment   
NB: For credit card payment, Maxon's Sale team will contact you to obtain your credit card details.
Direct Deposit
Please specify company name with payment details
Bank Name:  National Australia Bank
Branch : Revesby
BSB:  082-429
Account:  5306-854-06
Terms and Conditions
 
I have read and agree to Maxon Australia's terms and conditions for value added services.
 
By submitting this order form to Maxon Australia you agree to the Terms and Conditions of using Maxon Australia's value added service(s).
 

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