Affinity Vision Australia Pty Ltd

Secure My Wireless Booking Form

   [ Affinity Vision Australia Pty Ltd ]
We offer our product knowledge and many years of IT experience to help you make the right ADSL2+ choice and / or other broadband product option to suit your requirements.
Much like an "Insurance Broker" might do for insurance....     we do for Broadband products!
Affinity Vision Australia Pty Ltd Secure My Wireless ADSL2 Choice -- Broadband Enquiry Our Sipsorcery SIP number

NB: The above image has some old phone numbers that need updating....
  • New Land Line: 03 9012 2102 (Exetel DID number, replaces 03 9912 0504)
  • New SIP address: sip:853804@sipsorcery.com (replaces Voxalot SIP address)

    • Please fill as many details as you can to help ensure you get the best available advice from us:

    Absolute Minimum required fields marked: *


    Your Contact Details
    First Name: *
    Last Name: *
    Business Hours Phone:
     Ext.
    After Hours Phone:
    Mobile Phone:
    Mobile Network: Other:
     
    Current VoIP Service Provider: Other:
    VoIP Number [internal/DID]:

    NB: SIP / URI numbers then standard fixed line numbers may be called in preference to mobiles.
    However, Email will be the first preference.

    Email Address:
    *
     

    Please enter details of your current hardware and/or requirements for replacement or additional hardware:


    Referral Details
     If you were referred to this website, please let us know who referred you or how you came to know about this page.
    First Name:
    Last Name:

    Other information about referrer
    (website or other details):


    Referrers Email Address:
     
     
    The rest of this form is OPTIONAL, but useful if you want to consider broadband options too
    or
    just to provide further details.

    Your Potential ADSL / ADSL2 Service
    The following number is for a candidate ADSL service.
    [it must be a normal fixed line phone number using a Telstra owned copper]
    (ie. not an Optus service using their own cable).
    Service Phone Number:

    Service Address Details
    (full address please):

    Please enter any specific requirements / questions here:

    How soon would you upgrade to ADSL2+ if it was available to you now? 
     
    Your Current Internet Details
    (if applicable)
    Connection Type: Other:
    Current ISP: Other:

    Current Plan Name and/or Summary:

     
    Your Current Telephone Details
    Current Telephony Biller: Other:

    Summary of fixed line usage, including call spend costs:

    Have you considered VoIP?
    Please provide details:


    • If you wish to discuss something more urgently, then please contact us via this link
    • Your enquiry details will be attended to personally in due course.

    Important Privacy Information:

    All information attained in the form will be used solely for the intended purpose of assessing product suitability from the range of products available via Affinity Vision Australia Pty Ltd.
    No information will be shared with any third party without express permission from the information submitter.