ICONZ ADSL Move Address Request Form

Connection type
Is the New Line number Operational? yes no
Is your phone line a Business or Residential line? Business Residential
Have you informed your phone line service provider that you are moving address? Yes No
When is the line being installed?
Note:
ICONZ ADSL require an active phone line before we are able to submit your request for installation.
Please complete this form, however your request will not be submitted until the next working day following the date you have provided.

Note: ICONZ will submit this request; however a consolidated move address can only be carried out if your phone line provider submits their request with more than two working days notice before the move address RFS date. If there is less than two days lead time, the phone line will be moved without the ICONZ ADSL service and ICONZ will have to submit a new connection request.

Note: ICONZ will submit this request; however your ADSL connection will not be moved to your new address until your phone line provider has also received the request to move the phone line. Please contact your phone line provider and advise them that you are moving address.

What date is the new connection required? As soon as possible Requested Date
Date:

Customer Details
Contact Name:
Email Address:
ICONZ ADSL username

Connection
New connection type: Move Address Only ($0)
Move Address And Wiring ($167.00)
Site Contact Name:
Site Contact Mobile:

Telco Details
Existing ADSL line number:
New ADSL line number

New Address Details
Unit:
New Location Street Number:
Street Name:
Suburb
City

Billing Address
Is the billing address same as address Yes No
Address:
Suburb
City

Addtional Services

Notes