TSTT License Form-Service Agreement Final 012419 - BLANK 2022 (12) - 1
TSTT License Form-Service Agreement Final 012419 - BLANK 2022 (12) - 1
TSTT License Form-Service Agreement Final 012419 - BLANK 2022 (12) - 1
CUSTOMER DETAILS
FIRST NAME LAST NAME
Ronald GED
Brown
DATE OF BIRTH (DD/MM/YY) GENDER: F M
30/05/1970
ID1 TYPE: EBC ID DP PP ID2 TYPE: EBC ID DP PP
MOBILE CONTACT# WORK CONTACT# FIXED LINE CONTACT# PREFERRED CONTACT METHOD
18687514334 EMAIL
EMAIL ADDRESS:
SMS
PHONE
NO PROMOTIONAL CONTACT
EMPLOYER: OCCUPATION:
N/A WORK AREA: N S E W T’GO
TECH INSTALL
121701160838437 COE
358907345737899
Bills will be sent to the emal address provided above. PAPER BILL REQUIRED Y N
PAYMENTS AND CHARGES CUSTOMER DECLARATION
RECEIPT#
HANDSET/ SIM CHARGE:
INSTALLATION CHARGE: I declare that the information on this application is true and
accurate. I have read and agreed to TSTT’s Terms and Conditions
RELOCATION CHARGE: of Service.
SECURITY DEPOSIT: I understand and agree that I must pay for any services for the
minimum service period indicated above.
ADVANCE PAYMENT:
I hereby authorise TSTT to use, share, obtain and exchange my
credit and other personal information with credit bureaus, credit
VAT:
insurers, registers, other companies in the TSTT group and other
persons and companies with whom TSTT has financial dealings,
TOTAL DUE: as well as any other person as may be permitted or required by
law. I also authorize any person from whom TSTT seeks to obtain
TOTAL PAID: information in this regard to provide such information.
BALANCE BILLABLE: