Telstra Temporary Service Request For 2009

Submission of this form is a request to Telstra for temporary telecommunications services during the 46th Elmore Field Days - 6 to 8 October 2009.

All requests must be received by close of business 18 September 2009. Requests received after this date may not be fulfilled.

Please fill in ALL the boxes ...

Legal Entity Making Application:
Person or Company Name:

Trading Name:

Application Authorised By:
Name:

Telephone Number:

Fax Number:

Email Address:

Account Details

Existing Account
Consolidate to an existing Telstra Account? Yes No
If `Yes' Account Number:

OR
Consolidate to an existing Telstra Phone Number? Yes No
If `Yes' Telephone Number:

New Account
Is a New Telstra Account Number Required? Yes No
If a new account is required, please supply your ACN:

Billing Address:

Previous Field Days' Services
Have you exhibited at previous Elmore Field Days? Yes No
If `Yes' please list the services you have accessed previously:

Site Information And Service/Equipment Requested
Site/ Number:

On Site Contact Person:

Mobile Phone Number:

Type of Service Required:
Standard Telephone: / Other (detail below)
Quantity of lines required:
Long Distance Carrier Choice:

Access Level: Open / Local, STD & Mobile / Local Only
Equipment Required: Socket Only / Rental Telephone Required
Additional Requirements:

Service Dates
Connection Date:
eg: 7 Oct 2009
Cancellation Date:
eg: 9 Oct 2009

Sponsor Icons - Tractor & Machinery Association, Telstra Countrywide, Field Days Association.

Cr Peter Williams
Mayor Shire of Campaspe

The Elmore Field Days are one of the highlights of the rural events calendar in Victoria and southern New South Wales. The Shire of Campaspe congratulates the Elmore Field Day Committee for their ongoing enthusiasm and commitment and their plans for the Elmore Events Centre.