Blue IQ - Broadband Internet Application

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Use the form below to sign up to Blue iQ broadband. After we have received the form, we'll contact you to confirm the details and collect payment information. If you have any questions please feel free to call us on 1300 Blue iQ.

Plan Details*
Please choose your broadband plan.

Installation Options*
Please choose which installation option you would like.

Self Installation :	$199.00	Professional Installation :	$299.00
Wireless Self Install :	$249.00	Wireless Pro Install :	$349.00
Activation Only Fee :	$119.00	Churn Only Fee :	$49.00

Static IP Address
Some network services require a static IP address. If you have been advised by a software or system vendor that you require a static IP address, please tick the box and we will let you know what your static IP address is when we install your broadband..

I require a static IP address :

$4.95 per month.

Churn Authorisation
If you are switching to Blue iQ from another provider you will need to download a churn authorisation form, which gives us your permission to move your broadband service over to Blue iQ. Click here to down load the form, then either fax it back to us on 07 4980 0001, mail it to PO Box 757, Emerald, QLD 4720 or drop it in to us at 5 Hogan's Road, Emerald, QLD 4720. If you have any problems opening the form please give us a call on 1300 Blue iQ.

Broadband Service Number
Please enter the number of the telephone line that the broadband service will be connected to. This number is generally your main number, however you can also use a fax line or an eftpos line. Please not you cannot have a broadband service on an ISDN line. Please enter the full number including area code.

Service number* :

10 digits including area code

Your new email address
If you need or would like a new email adress, perhaps because you're leaving your old provider, or this is a new service, please choose an email address below. If you already have an email address that you won't lose by leaving your current provider, such as a Hotmail or Yahoo! address, or a company email address, you do not need to choose an email address here, although you're more than welcome!.

Preferred email address :

@ iq.net.au

Choose a Password
Please choose a password for your broadband service. If you are also having an iq.net.au email address, this password will be your email password too.

Password* :	Minimum 6 characters
Confirm Password* :

Contact Details
Please enter your contact details.

Name* :
Date of Birth* :	DD/MM/YYYY, e.g. 21/07/1982
Company :
Trading Name :
Phone* :
Fax :
Mobile :
Email* :

Service Address Details
Please enter the physical address where the service is to be located. You can often find this on your phone bill. Please do not put a PO box or postal address here.

Address line 1* :
Address line 2 :
Address line 3 :
Suburb* :
State* :
Postcode* :

Billing Address Details
Please enter the address you would like invoices and postal correspondence sent to.

Billing Address line 1 :
Billing Address line 2 :
Billing Address line 3 :
Billing Suburb :
Billing State :
Billing Postcode :

Miscellaneous
Use this area to detail any special requests or instructions you may have.

Special Instructions

Terms and Conditions
Please indicate that you have read, understood and agree to be bound by Blue iQ's Terms and Conditions as posted from time to time at http://www.blueiq.com.au/termsAndConditions.html.

I have read, understood and agree to be bound by Blue iQ's Terms and Conditions :

Almost Done!
Just fill in the image verification box and click submit to send your application to us. After we have received your application, we will contact you to confirm details and collect payment information.

To help us prevent misuse of this form, please enter the letters in the image into the text box. If the image is difficult to read, Click here to load another image.