Home Wireless Broadband New Customer Details

This form is for new residential Home Wireless Broadband customers. For commercial or business accounts, please complete the Commercial New Customer Application Form.

HWBB New Customer Application Form

1Your Account

2Your Service

3Confirmation

About You
Your First Name*
Your Last Name*
Email*
Do you have a reference number for your Wireless Broadband enquiry?*
If you've been talking to us by e-mail about Wireless Broadband, we might have given you a reference number (a six or seven digit number associated with your request).
- Yes
- No
What is your reference number?*
Do you have a referral or discount code?

If you have a referral or discount code enter it here. If there is an issue with your code, we'll let you know!
Are you an existing Real World customer?*
- Yes
- No
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

The address where your NBN Service will be installed.
Your Mobile Number*
Please provide in international format (e.g. 614XXXXXXXXX). We require a phone number to contact you.
Your Date of Birth*
We record your date of birth for your security and may use it to help identify you.
Identification Information
As part of signing up for a new internet service, we need to perform some basic identification to prove that you are, in fact, you. We will ask you for a copy of the front and back of this ID document when we send you your contract.

If you don't have an ID document listed (Medicare Card, Passport, Australian Drivers License) please contact our office on 1300 798 718.
Identification Type*
State of Issue*
Identification Number*

The ID number as it appears on your document
Reference Number*

Your unique Medicare reference number from your medicare card.
Expiry Date*

The date that the document expires.
Country of Issue*
Additional Account Contacts
Would you like anyone else to have access to your account?*
- Yes
- No
First Name*
Last Name*
Email*
Mobile Number*
Please provide in international format (e.g. 614XXXXXXXXX). We require a phone number to contact you.
Date of Birth*
We record your date of birth for your security and may use it to help identify you.

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Home Wireless Broadband New Customer Details

HWBB New Customer Application Form

About You

Identification Information

Additional Account Contacts

Billing Details

Other details