PSTN ISDN FSR Application Form

Head Office Unit 19, 256-258 Musgrave Road

Coopers Plains, QLD 4108

North Brisbane Office Shop 2, 107 Morayfield Road, Morayfield, QLD 4506

Tel: 1300 858 723 Fax: 1300 785 685

Unit 19 256-258 Musgrave Road, Coopers Plains, QLD 4108 Shop 2, 107 Morayfield Road, Morayfield, QLD 4506

Ph: 1300 858 723 Fax: 1300 785 685

Please place your initials on every page and sign the last page before returning the signed quote to QCS Group via fax: 1300 785 685 or email to provisioning@qcsgroup.com.au

All prices are quoted including GST.

QCS Group PSTN + ISDN2 Please complete all sections (A, B, C) before returning this form. Please return form by fax to 1300 785 685 or you can mail it to Provisioning, QCS Group, Unit 19, 256-258 Musgrave Rd, Coopers Plains, QLD 4502 Section A

Customer Details

Name (In Full):

Company Name: ABN:

Address Street Number and Name:

City/Suburb: State: Postcode:

Email: Date of Birth: Driver’s License/Medicare Number:

Daytime Phone: Mobile: Evening Phone:

Billing/Postal Address (if different from above)

Street Number and Name:

City/Suburb: State: Postcode:

Section B - New Telephone Service

New Telephone Service Site 1 Address Details

Street Number and Name:

City/Suburb: State: Postcode:

Please select a Telephone Service type below and enter the desired number of lines.

☐ PSTN ☐ ISDN2 ☐Business Fax Number of Lines:

☐ PSTN ☐ ISDN2 ☐Business Fax Number of Lines:

☐ PSTN ☐ ISDN2 ☐Business Fax Number of Lines:

Unit 19 256-258 Musgrave Road, Coopers Plains, QLD 4108 Shop 2, 107 Morayfield Road, Morayfield, QLD 4506

Ph: 1300 858 723 Fax: 1300 785 685

Please place your initials on every page and sign the last page before returning the signed quote to QCS Group via fax: 1300 785 685 or email to provisioning@qcsgroup.com.au

All prices are quoted including GST.

Section B - New Telephone Service Continued

New Telephone Service Site 2 Address Details

Street Number and Name:

City/Suburb: State: Postcode:

Please select a Telephone Service type below and enter the desired number of lines.

☐ PSTN ☐ ISDN2 ☐Business Fax Number of Lines:

☐ PSTN ☐ ISDN2 ☐Business Fax Number of Lines:

☐ PSTN ☐ ISDN2 ☐Business Fax Number of Lines:

New Telephone Service Site 3 Address Details

Street Number and Name:

City/Suburb: State: Postcode:

Please select a Telephone Service type below and enter the desired number of lines.

☐ PSTN ☐ ISDN2 ☐Business Fax Number of Lines:

☐ PSTN ☐ ISDN2 ☐Business Fax Number of Lines:

☐ PSTN ☐ ISDN2 ☐Business Fax Number of Lines:

New Telephone Service Site 4 Address Details

Street Number and Name:

City/Suburb: State: Postcode:

Please select a Telephone Service type below and enter the desired number of lines.

☐ PSTN ☐ ISDN2 ☐Business Fax Number of Lines:

☐ PSTN ☐ ISDN2 ☐Business Fax Number of Lines:

☐ PSTN ☐ ISDN2 ☐Business Fax Number of Lines:

Unit 19 256-258 Musgrave Road, Coopers Plains, QLD 4108 Shop 2, 107 Morayfield Road, Morayfield, QLD 4506

Ph: 1300 858 723 Fax: 1300 785 685

Please place your initials on every page and sign the last page before returning the signed quote to QCS Group via fax: 1300 785 685 or email to provisioning@qcsgroup.com.au

All prices are quoted including GST.

Section B – Transfer of Existing Telephone Services

Current Telephone Account Details

Telephony Account Title: ☐ MR ☐ MRS ☐ MISS ☐ MS ☐ MSTR ☐ DR ☐ PROF

Telephone Account First Name: Telephone Account Surname:

Telephone Account Company Name: Account Number:

Address: Sub Address:

Street Number and Name:

City/Suburb: State: Postcode:

Transfer of Existing Telephone Service Site 1 Address Details

Street Number and Name:

City/Suburb: State: Postcode:

Please type the telephone number and select the Telephone Service type of the service you wish to transfer below.

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

For number ranges, only enter main number in range.

Transfer of Existing Telephone Service Site 2 Address Details

Street Number and Name:

City/Suburb: State: Postcode:

Please type the telephone number and select the Telephone Service type of the service you wish to transfer below.

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

For number ranges, only enter main number in range.

Unit 19 256-258 Musgrave Road, Coopers Plains, QLD 4108 Shop 2, 107 Morayfield Road, Morayfield, QLD 4506

Ph: 1300 858 723 Fax: 1300 785 685

Please place your initials on every page and sign the last page before returning the signed quote to QCS Group via fax: 1300 785 685 or email to provisioning@qcsgroup.com.au

All prices are quoted including GST.

Transfer of Existing Telephone Service Site 3 Address Details

Street Number and Name:

City/Suburb: State: Postcode:

Please type the telephone number and select the Telephone Service type of the service you wish to transfer below.

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

For number ranges, only enter main number in range.

Transfer of Existing Telephone Service Site 4 Address Details

Street Number and Name:

City/Suburb: State: Postcode:

Please type the telephone number and select the Telephone Service type of the service you wish to transfer below.

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

Service Number: ☐ ISDN2 ☐ PSTN ☐ Business Fax

For number ranges, only enter main number in range.

Unit 19 256-258 Musgrave Road, Coopers Plains, QLD 4108 Shop 2, 107 Morayfield Road, Morayfield, QLD 4506

Ph: 1300 858 723 Fax: 1300 785 685

Please place your initials on every page and sign the last page before returning the signed quote to QCS Group via fax: 1300 785 685 or email to provisioning@qcsgroup.com.au

All prices are quoted including GST.

Section C – Standard Business Rates

QCS Group Business Rates

Rate Plan Tier 1 Tier 2 Tier 3 Tier 4

Avg. Monthly Spend $1 - $1000 $1000 - $2000 $2000 - $8000 Over $8000

Local Calls ISDN (Untimed) 25c 25c 25c 25c

Local Calls PSTN 14c 13.5c 13c 12c

National Calls 10c/min 9c/min 8c/min 7.5c/min

Flag Fall 5c 4c Nil Nil

Fixed to Mobile 28c/min 27c/min 26c/min 24c/min

Calls to 13/1300 numbers 40c 40c 40c 40c

Flag Fall 5c 4c Nil Nil

Monthly Access Fee

Service Cost

PSTN $39.95

ISDN 2 BusinessLine Complete/ ISDN 2 Direct Indial Associated Line

$98.00

ISDN 2 Enhanced BusinessLine Complete $104.00

ISDN 10 BusinessLine Complete $478.00

ISDN 20 BusinessLine Complete $913.00

ISDN30 BusinessLine Complete $1,270.00

Every subsequent 10 channels $423.50

ISDN Direct Indial per 100 Number Block $69.75

ISDN Direct Indial per 100 Number Block Reservation $96.00

Calling Number Display/CLIP on an ISDN2 service $10.20

Calling Number Display/CLIP on an ISDN 10/20/30 service $20.35

ISDN Line Hunt $5.50

PSTN Line Hunt $5.50

Number Redirection (standard service, per number per month)

$33.00

Unit 19 256-258 Musgrave Road, Coopers Plains, QLD 4108 Shop 2, 107 Morayfield Road, Morayfield, QLD 4506

Ph: 1300 858 723 Fax: 1300 785 685

Please place your initials on every page and sign the last page before returning the signed quote to QCS Group via fax: 1300 785 685 or email to provisioning@qcsgroup.com.au

All prices are quoted including GST.

International Call Rates

Top 10 Countries – International Call Rates

Country Rates

United Kingdom $0.04 per minute

Philippines $0.17 per minute

USA $0.04 per minute

New Zealand $0.04 per minute

India $0.04 per minute

Indonesia $0.10 per minute

China $0.04 per minute

Thailand $0.04 per minute

Ireland $0.04 per minute

Canada $0.04 per minute

Unit 19 256-258 Musgrave Road, Coopers Plains, QLD 4108 Shop 2, 107 Morayfield Road, Morayfield, QLD 4506

Ph: 1300 858 723 Fax: 1300 785 685

Please place your initials on every page and sign the last page before returning the signed quote to QCS Group via fax: 1300 785 685 or email to provisioning@qcsgroup.com.au

All prices are quoted including GST.

Section C – Included Value Rates

QCS Group Business PSTN Included Value Rates

Call Types Included Value

Monthly Recurring Charge Per PSTN Line $107.50

Line Rental (x1) Included

Local & 13/1300 Included

National Calls Included

Calls to Australian mobiles Included

All other call types As set out in this application form

QCS Group ISDN2 Included Value Rates

Call Types Included Value

ISDN2 Monthly Recurring Charge $257.00

Line Rental (x2) Included

Local & 13/1300 Included

National Calls Included

Calls to Australian mobiles Included

All other call types As set out in this application form

Top 10 Countries – International Included Value Call Rates

Country Rates

United Kingdom $0.11 per minute

Philippines $0.46 per minute

USA $0.11 per minute

New Zealand $0.11 per minute

India $0.57 per minute

Indonesia $0.57 per minute

China $0.29 per minute

Thailand $0.57 per minute

Ireland $0.17 per minute

Canada $0.11 per minute

Unit 19 256-258 Musgrave Road, Coopers Plains, QLD 4108 Shop 2, 107 Morayfield Road, Morayfield, QLD 4506

Ph: 1300 858 723 Fax: 1300 785 685

Please place your initials on every page and sign the last page before returning the signed quote to QCS Group via fax: 1300 785 685 or email to provisioning@qcsgroup.com.au

All prices are quoted including GST.

Section C – Other Calls ISDN

ISDN Voice Miscellaneous Calls

Number Prefix Service Call Connection Fee Rates

0 Emergency Services $0.00 $0.00

0071… Satellite telephone service - Telstra $0.29 $0.34

01451-3… Satellite telephone service - Optus $0.29 $2.57

01471… Satellite telephone service - Telstra $0.51 $0.86

0161-0163… Paging service $0.29 $0.00

0166-0169… Paging service $0.29 $0.00

0192… Data access service $0.29 $0.00

0198… Data access service $0.29 $0.00

0500… Universal personal telecommunications services $0.29 $0.07

1100 Community service - Dial Before You Dig $0.29 $0.00

1194 Community service - time $0.50 $0.00

1196 Community service - weather $0.50 $0.00

1221 AAPT international faults and difficulties $0.00 $0.00

1222 AAPT call costs and enquiries $0.00 $0.00

1223 Directory assistance - local and national $0.57 $0.00

124… Operator services - refer to list - -

125… Operator services - refer to list - -

12711 Pre-selection verification service $0.00 $0.00

13… Local rate service $0.33 $0.00

130… Local rate service $0.33 $0.00

1300… Local rate service $0.33 $0.00

180… Freephone service $0.00 $0.00

1800… Freephone service $0.00 $0.00

183… Supplementary control service $0.00 $0.00

18500 Universal personal telecommunications profile access service $0.00 $0.00

189… Calling card service $0.00 $0.00

190… Premium rate services – refer to list - -

Unit 19 256-258 Musgrave Road, Coopers Plains, QLD 4108 Shop 2, 107 Morayfield Road, Morayfield, QLD 4506

Ph: 1300 858 723 Fax: 1300 785 685

Please place your initials on every page and sign the last page before returning the signed quote to QCS Group via fax: 1300 785 685 or email to provisioning@qcsgroup.com.au

All prices are quoted including GST.

Section C – Other Calls ISDN Continued

ISDN Voice Operator Service Calls

Number Prefix Service Call Connection Fee Rates

12451 Yellow Pages call connect $1.57 $0.07

12455 Telstra directory assistance - local and national - with connect option $1.43 $0.07

12456 Telstra call connect $1.43 $0.07

125102 Telstra MessageBank - away retrieval $0.29 $0.00

125105 Telstra MobileNet - sales, billing, product enquiries, repairs and faults $0.29 $0.00

125106 Telstra MobileNet - sales, billing, product enquiries, repairs and faults $0.29 $0.00

125109 Messagebank Memo Roaming $0.33 $0.00

125111 Telstra MobileNet - sales, billing, product enquiries, repairs and faults $0.29 $0.00

125112 Telstra MobileNet - sales, billing, product enquiries, repairs and faults $0.29 $0.00

125118 Telstra pay by phone $0.29 $0.00

125125 Optus customer service $0.29 $0.00

12552 Telstra call pricing information $0.29 $0.00

12554 Telstra changed number information service $0.29 $0.00

Unit 19 256-258 Musgrave Road, Coopers Plains, QLD 4108 Shop 2, 107 Morayfield Road, Morayfield, QLD 4506

Ph: 1300 858 723 Fax: 1300 785 685

Please place your initials on every page and sign the last page before returning the signed quote to QCS Group via fax: 1300 785 685 or email to provisioning@qcsgroup.com.au

All prices are quoted including GST.

Section C – Other Calls ISDN Continued

ISDN Voice Premium Rate Calls

Number Prefix Service Call Connection Fee Rates

1900240022 Market facts $0.21 $0.50

1900900236 GDC Fordigraph Pty Ltd $0.00 $15.60

1900900800 Infodial Australia $7.74 $0.00

1900900867 GDC Fordigraph Pty. Ltd. $14.30 $0.00

1900911206 Local and overseas market, future, rates indices $0.21 $1.36

1900911481 National time zones $0.21 $1.07

1900911522 Capital city and regional forecasts $0.21 $1.07

1900911526 National and international news $0.21 $1.07

1900912336 News $0.21 $1.36

1900914450 National and international weather $0.21 $1.07

1900914494 Stock and share prices $0.21 $1.07

1900914504 Financial indices and news $0.21 $1.07

1900919958 Lottery West Results (Salmat Interactive) $0.72 $0.00

1900922334 GDC Fordigraph Postage Reset $17.88 $0.00

1900922996 JJJ Surf Alert $0.00 $1.36

1900926110 BOM Weather Call

(Port Phillip, Western Port Bays and Bass Straight) $0.00 $1.10

1900926113 BOM - Info Dialling Service $0.36 $1.00

1900927826 ASTAMP postal service $14.30 $0.00

1900931239 National time zones $0.21 $1.36

1900931240 National time zones $0.21 $1.36

1900931247 Financial index and news $0.21 $1.36

1900931255 National and international news $0.21 $1.36

1900936133 Vinal Master Pro $0.00 $2.86

1900937012 Financial indices and news $0.21 $1.36

1900937104 Stock and share prices $0.21 $1.36

1900937106 National time zones $0.21 $1.36

1900937107 Capital city and regional forecasts $0.21 $1.36

1900937118 Financial index and news $0.21 $1.36

1900955350 BOM - WA Marine Service $0.36 $1.00

1900955361 BOM - Weather Service $0.36 $1.00

1900956524 Home Beautiful $0.00 $0.79

1900957665 GT interactive $0.21 $2.15

1900959051 Examination results $0.21 $2.79

1900959946 Racing Selections $0.00 $2.79

1900966171 Broad Systems Australia - Astrology $0.00 $3.58

1900967030 JB Were share market report $0.21 $0.64

1900969906 Bureau of Meteorology – NSW Southern Inland Service $0.00 $1.00

1900969927 QLD Western Districts Service $0.00 $1.00

1900969928 QLD Southeast Districts Service (except Southeast Coast) $0.00 $1.00

1900969930 BOM Weather Call (Bass Straight) $0.00 $1.10

1900969931 BOM Weather Call (Nth Bass Straight) $0.00 $1.10

1900969932 BOM Weather Call (Sth Bass Straight) $0.00 $1.10

1900969933 BOM Weather Call (Eastern Bass Straight) $0.00 $1.10

1900969934 BOM Weather Call (Western Bass Straight) $0.00 $1.10

1900969966 BOM Weather Call (Victoria) $0.00 $1.10

1900999227 Palm Teq $0.00 $5.65

1900999279 ASX Lodgement service $50.05 $0.00

1901145000 NAB Fax $0.50 $0.00

1901145032 National Bank service $0.50 $0.00

Unit 19 256-258 Musgrave Road, Coopers Plains, QLD 4108 Shop 2, 107 Morayfield Road, Morayfield, QLD 4506

Ph: 1300 858 723 Fax: 1300 785 685

Please place your initials on every page and sign the last page before returning the signed quote to QCS Group via fax: 1300 785 685 or email to provisioning@qcsgroup.com.au

All prices are quoted including GST.

Section C – Other Calls ISDN Continued

ISDN Voice Premium Rate Calls (Continued)

Number Prefix Service Call Connection Fee Rates

1901148590 KH Services $28.60 $0.00

1902210986 National and international news $0.21 $1.36

1902212112 Go Connect help desk $0.21 $2.79

1902213096 Computer share registry services $0.21 $2.36

1902222244 Elite Tax Support Line $0.00 $1.72

1902223101 Quicken Software Support $0.00 $6.36

1902223239 Quicken Software Support $0.00 $6.36

1902241072 International weather $0.21 $1.36

1902241143 National time zones $0.21 $1.36

1902241148 Capital city and regional forecasts $0.21 $1.36

1902241155 International weather $0.21 $1.36

1902241174 Stocks and shares prices $0.21 $1.36

1902241180 Financial indices and news $0.21 $1.36

1902241558 News on the hour $0.21 $0.50

1902241677 Capital city and regional forecasts $0.21 $1.36

1902241678 International weather $0.21 $1.36

1902241682 Local and overseas market news $0.21 $1.36

1902241691 National and international news $0.21 $1.36

1902243712 Adobe Systems $0.21 $4.29

1902250299 Lawn Care Services $3.58 $0.00

1902260568 Darling Harbour info $0.21 $0.72

1902262626 OziSoft support line $0.21 $2.57

1902263456 Cinema information line $0.21 $0.79

1902267041 FRARMA $15.37 $0.00

1902555512 Dialect Interactive - News Connect $0.72 $0.00

1902557707 Mnet Mobile Pty Ltd $0.72 $0.00

1902559508 Salmat Voting $0.72 $0.00

1902910026 MYOB Helpdesk $0.21 $2.50

1902935000 to 899 Weather fax $0.21 $0.94

1902935280 Coastal Waters Forecast $1.79 $1.79

1902941510 The Age market call $0.21 $1.36

1902941520 AFR market call $0.21 $1.36

1902941550 SMH market call $0.21 $1.36

1902941555 British visa application $0.21 $1.36

1902941570 ASX Journal market call $0.21 $1.36

1902941600 British High Commission visa and passport info $0.21 $1.36

1902941641 U.S. Embassy visa and passport info $0.21 $1.63

1902943010 ASIC - ACN Number Enquiries $0.00 $3.15

1902948666 Stockphone Company Search Service $32.56 $0.00

1902949005 Stockphone Company Search Service $49.55 $0.00

1902961500 Herald Sun market call $0.21 $1.36

1902965001 Frankotype - postralia $14.30 $0.00

1902983540 Employment and industrial relations advice $0.21 $5.65

Unit 19 256-258 Musgrave Road, Coopers Plains, QLD 4108 Shop 2, 107 Morayfield Road, Morayfield, QLD 4506

Ph: 1300 858 723 Fax: 1300 785 685

Please place your initials on every page and sign the last page before returning the signed quote to QCS Group via fax: 1300 785 685 or email to provisioning@qcsgroup.com.au

All prices are quoted including GST.

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General Terms and Conditions 1. All rates are inclusive of GST 2. Prices quoted are in $AUD 3. All pricing and other information contained in this document is COMMERCIALLY CONFIDENTIAL. In the event

of any unauthorised use or disclosure of any of the information contained in this document, QCS Group reserves the right to immediately withdraw this proposal and terminate its dealings with you without notice.

Included Value Plans Terms and Conditions 1. The Initial Period for each Included Value Plan service is 12 months. 2. A Service Installation Charge will apply to a new Individual Service unless You are churning from another

service provider to Our Service, in which case we will waive the Service Installation. 3. Unless otherwise indicated, all Charges:

i) Are in cents per minute; ii) Are calculated per second; iii) Are in Australian Dollars; and iv) Are quoted in cents inclusive of GST

4. The monthly recurring Charge applicable to Included Value Plan selected in your order for service (“Your Included Value Plan”) will: i) Cover the call types and usage that are denoted as “Included” in your included value plan; ii) For call types and usage that are denoted as Included but have a specific included dollar value, or

rate, include those call types and usage up to that value or charged at that rate; iii) Apply each month, irrespective of whether the service is used in that month and any unused credit for

included call types is forfeited at the end of each month; and iv) Be charged in advance on a monthly basis, with the first month of the initial period being applied on a

pro-rata basis. 5. We may withdraw the Included Value Plan at any time by giving you at least 30 days’ notice in writing. 6. How calls will be charged:

i) Call types that are fully included (ie “Included”) will be charged at $0.00. ii) Call types that are partially included (ie “$x included”) will be charged as follows:

Calls to national Mobiles: $0.17/minute International calls: at the rates set out on our website http://www.qcsgroup.com.au/international-rates

iii) Per minute charges are charged in 1 second increments.

Excluded Services

1. All services that are not denoted in Your Included Value Plan as Included are excluded from the Monthly recurring Charge (“Excluded Services”), including but not limited to: i) Calls made in excess of any Included specified dollar value; ii) Data calls of any type; and iii) Any Service used in breach of the Acceptable Uses policy.

2. If applicable, you must pay any additional charges for the provision of any of the above services you sign up for to continue. We will advise you of any additional charges should additional charges arise from the provision of your service.

3. Withdrawal fees may apply for any orders we receive from you that are withdrawn on request from yourself or in the event that we are unable to proceed with the provision of your service (ie Infrastructure Limitations). Withdrawal fees will vary depending on the stage of the provisioning process.

Unit 19 256-258 Musgrave Road, Coopers Plains, QLD 4108 Shop 2, 107 Morayfield Road, Morayfield, QLD 4506

Ph: 1300 858 723 Fax: 1300 785 685

Please place your initials on every page and sign the last page before returning the signed quote to QCS Group via fax: 1300 785 685 or email to provisioning@qcsgroup.com.au

All prices are quoted including GST.

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Early Termination and Cancellation Charge If:

i) You terminate an individual service before the initial period expires (including as a result of us not accommodating any request by you for a service modification or relocation of the service); or

ii) We terminate a Service in accordance with the Agreement for a breach by You (including termination for a breach of QCS Group’s Acceptable Uses policy),

You will be liable to pay a Cancellation Charge calculated as the sum of: iii) the Monthly Recurring Charge multiplied by the number of months, or part thereof, between the date

of termination and the end of the Initial Period; and iv) any rebates, credits, refunds or discounts (including but not limited to any waiver of port-in credits),

provided to you in respect of the service. Service Barring

1. Barred services means that you will be unable to receive incoming or make outgoing calls except for calls to emergency services.

2. If your ISDN service is barred due to non-payment, or from breach of our Acceptable Uses policy, you are liable to pay the fee of $165 including GST plus another $165 including GST for unbarring your service.

QCS Group’s Acceptable Uses policy i) The Service is subject to QCS Group’s Acceptable Uses policy. By signing this application form, you

agree to comply with the Acceptable Uses policy. ii) We reserve the right to vary the terms of the Acceptable Uses policy from time to time. A copy of the

Acceptable Uses policy is available at http://www.qcsgroup.com.au/terms-and-conditions/ under 9. Miscellaneous section.

Section D

Payment Options

☐ Visa ☐Mastercard ☐ Amex ☐ EFT ☐ Cheque

Card Number: Expiry Date:

Name On Card: 4 Digit Security Code (AMEX Only)

I wish to use the above card (‘Card’) to pay for the above goods/services supplied to me by QCS Group (‘the merchant’). I hereby authorise the Merchant to debit my Card Account with the amount and at the intervals specified above and in the event of any change in the charges for these goods/services to alter the amount from the appropriate date in accordance with such change. This authority shall stand, in respect of the above specified Card and in respect of any Card issued to me in renewal or replacement thereof, until I notify the Merchant in writing of its cancellation

By Signing this application form, I confirm that I have read and understand the Terms and Conditions appearing at http://www.qcsgroup.com.au/terms-and-conditions/

Customer Name (Please Print): Date:

Customer Signature: Position (Companies only):