Step 1 of 6 - Company Details 0% Thank you for signing up for a ZettaNet service. This form is used to gather information which is used to set up your ZettaNet account. The information you will need to provide us with is your Company details, details for a Primary Account Contact as well as Operational and Accounts Payable contacts and your payment information. If you wish to print a copy of this form and return you may do so by downloading the form here: Customer Information Form Company DetailsCompany Name* ABN / ARBN* Street Address* Suburb* State*ACTNSWNTQLDSATASVICWAPost Code* Phone Number* Primary Account ContactThis person has authority over all account aspects, including service ordering, modifications, payments and contracts.Full Name* Position* Email Address* Phone Number* Mobile Number* Operational ContactThis person or company typically supports the services internally and has some level of knowledge to communicate technical service issues.Full Name* Position* Email Address* Phone Number* Mobile Number* Accounts Payable ContactWhere should we email invoices to?* Accounts Contact Name* Accounts Contact Email Accounts Phone Number* Payment Type*Credit CardDirect DebitCredit CardCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Direct Debit Request“You” request and authorise ZettaNet Pty Ltd (Debit User ID 375019) to arrange, through its own financial institution, a debit to your nominated account any amount ZettaNet Pty Ltd, has deemed payable by you. This debit or charge will be made through the Bulk Electronic Clearing System (BECS) from your account held at the financial institution you have nominated below and will be subject to the terms and conditions of the Direct Debit Request Service Agreement.Direct Debit Request Account Holder's Name Bank Name BSB Number Account Number Date Of Agreement Actions Edit Delete There are no Direct Debit Requests. Add Direct Debit Request Maximum number of direct debit requests reached.
