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Please fill in all entries below 1. Personal Details Select a Title: Mr Mrs Ms Surname:   Given Name:   House Number:   Street Name:   Suburb:   Town/City:   Select a Country: Australia New Zealand Post Code:   Phone (After Hour):   Phone (Business Hour):   Mobile Number:   Fax:   Email:   Type of Residence: Unit Town House Single Storey Double Storey Full Installation Required: Yes No Smart Card Only Required: Yes No Extra Outlet In Another Room Required: Yes No

Card Details Visa MasterCard Others For security reasons, Please provide your card & Driver's License number when we call you 2.Credit card payments I authorize Sun TV Australia Pty, until further notice (or until a specified date) to charge my Mastercard/Visa account, installation cost and quarterly subscription as and when payments become due. I will advice you in writing if the card is lost, stolen or if I wish to close my card account or cancel the Authority

3. Confirmation This Contract is made between Sun TV Australia Pty Ltd and me, the person named on this form. Sun TV Australia will provide the Sun TV channel via digitial satellite equipment subject to the terms and conditions of this contract.I confirm that all my information given in this contract is correct. I have also read and agree to be bound by the terms & conditions.