I (the reader and duly authorised person) hereby apply for the supply of a network connection and services in accordance with the Smartlinx3 Terms and Conditions Dated September 2008 and the currently issued Schedule of Services and Charges. I declare that I know of no debt owing to Smartlinx3 Ltd in respect of previous failure to pay and I agree to pay for all services and connections as set out in the current Smartlinx3 Schedule of Services and Charges. I agree to give at least three month’s notice of intention to vacate, disconnect or reconnect the premises.

I understand that any personal information given to me is for a lawful purpose and will be used solely for the purposes of managing and supplying network connections and services and the business of Smartlinx3, and I have a right of access to, and correction of, that information.

Transmission of a completed Customer Application Form constitutes an order for supply of services and will be acted upon by Smartlinx3. Email to Sales@smartlinx3.co.nz or post to PO Box 25017, Panama St, Wellington 6146.

Full name of Client Company requiring Smartlinx3 Service *
Company Trading Name *
Contact Email Address *
Client Order Number *
Service requirement date *
Internet Service Provider (ISP) if known
Name of company arranging service if other than actual Client Company

Service Required – See Rate Card for more details.

	Connection Features (Tick as appropriate)	Additional Information	Install $	Mthly $
Direct Connection Speed	Smart 10 Smart 100 Smart 1000
Wireless Connection  Speed	DM 100 Sole 10 Sole 11 Sole 20 Sole 45 Multi 2 Multi 4 Multi 10
CafeNET Access Point	Yes No	Number. required?

Contract Term             12 mths 24 mths 36 mths

Please note: Installation can not be completed until a Customer Technical Details Form is submitted  

I hereby order the services I have indicated above and agree to abide by the Smartlinx3 Standard Terms and Conditions dated September 2008:

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