Join Us » Smartel Ltd

Residential Application Form

Name*

Date of Birth (e.g 20/2/1980)

Address

Driving License

Contact Phone

Mobile Phone

Email*

Phone to be connected

Do you want Smartel boardband ?

Do you currently have broadband?

If yes, is your existing Broadband coming into your premise via your phone line?

Please select your current Internet Service Provider

Broadband Phone Number:

what broadband plan do you want to apply?

Telephone Provider?

Telecom New Zealand
Telstra clear
Other Provider

Telecom Account Number:

Preferred broadband Username:

Conditions

I/we certify that the information given above is true and correct. I personally guarantee payment of all invoices received from Smartel within the period agreed upon on the invoice.

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Webmail

Account Manager

Residential

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