Customer Information Form

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

Primary Account Contact
This person has authority over all account aspects, including service ordering, modifications, payments and contracts.
Full Name*
Position*
Email Address*
Phone Number*
Mobile Number*

Operational Contact
This 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*

Payment Type*
Credit Card
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number 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

There are no Direct Debit Requests.

Company Details