+-------------------------------------------------------+ | Celestial Enterprises | | Telephone (03) 9724 9661 | | PO Box 235 Ringwood, Victoria, 3134, Australia | +-------------------------------------------------------+ +---------------------------------+ |Internet Account Application Form| +---------------------------------+ * Personal Information * -------------------- Title (circle one) : Mr/Mrs/Miss/Ms Full Name : ___________________________________ Birth Date : __/__/____ Home Phone : ____________________ Work Phone : ____________________ Fax (Optional): ____________________ Postal Address : ________________________________________ ________________________________________ ________________________________________ * Internet Account Information * ---------------------------- Subscription Level (circle one): Simply Email/Lite Access/Extra Access/Traveller/Highway Hog Account Name (Max. 8 Characters, Lower-Case) Preferences: (1) ____________ @celestial.com.au (2) ____________ @celestial.com.au (3) ____________ @celestial.com.au (4) ____________ @celestial.com.au Password (Min. 6, Max. 16, Alpha/Numeric, Place a slash in any zero's): ____________________ (Note: Password is Case sensitive) Current Subscription Rates: +-----------------------------------------------------------------------+ |Subscription|Time per Day|Time per Call|Time B/W Calls|Duration| Cost | | Level | (Minutes) | (Minutes) | (Minutes) | (Days) | | +------------+------------+-------------+--------------+--------+-------+ |Simply Email| 30 | 30 | 5 | 365 | $99.00| +------------+------------+-------------+--------------+--------+-------+ |Lite Access | 60 | 60 | 5 | 365 |$143.00| +------------+------------+-------------+--------------+--------+-------+ |Extra Access| 120 | 60 | 5 | 365 |$176.00| +------------+------------+-------------+--------------+--------+-------+ | Traveller | 180 | 90 | 5 | 365 |$209.00| +------------+------------+-------------+--------------+--------+-------+ | Highway Hog| 240 | 120 | 5 | 365 |$242.00| +------------+------------+-------------+--------------+--------+-------+ Note: All prices quoted include GST. * Agreement Information (Signature Required) * ------------------------------------------ I have read the "Celestial Enterprises Terms and Conditions of Use", and agree to abide by it. If the applicant is under 18 years of age, it must be signed by the applicants parent/guardian. In the case of the applicant being under 18 years of age, I the parent/guardian agree to be responsible for the actions of the applicant while using their account under Celestial. Full Name (Block Letters): ________________________________________ Signed : ____________________ Date : __/__/____ * Logging the Application * ----------------------- After the application form has been completed & signed. Attach a *Cheque for the full amount of the selected Subscription Level and Post to: Celestial Enterprises Attention: Registration PO Box 235 Ringwood VIC 3134 Upon receipt of the applicants form, the applicant will be notified by phone of any discrepancies within the application form and/or of account activation. For further queries please feel free to contact registration via Telephone (03) 9724 9661 or via Email at register@celestial.com.au * All Cheques to be made Payable to "Celestial Enterprises" *