HTML Preview Business Name Transfer Letter page number 1.
Change of Ownership Form
Return this form by: Fax 02 9850 0813
In person 65 Waterloo Road, North Ryde, NSW 2113
Post PO Box 1844, Macquarie Centre, North Ryde NSW 2113
Email [email protected] Enquiries 13 14 23
Register Online www.tpg.com.au
Please include a copy of identication of both existing and new
account owner. Allow two to three working days to process this form.
D
B
New Service Owner
Name
Service Number
Address
Suburb/Town
State Post Code
Phone
Mobile
Email
Date of Birth
Signature
( )
SIGNATURE
NAME
DATE
D
Agreement
I declare that in signing this document I am now responsible for the
above mentioned account. I understand that I am liable for any
current debit balance and remaining contract period.
Furthermore I have read, understood and agree to abide by TPG’s
Terms and Conditions as stated overleaf, and verify that I am over 18
years of age and am able to enter into a legally binding contract.
NOTE: If you wish to relocate the service after the change of ownership
is completed, you will be contacted by our moving home team.
Day Month Year
/ /
New Service Owner Payment Details
NOTE: You must nominate only one payment method. Customers who provide TPG
with an American Express or Diners Club cards incur a surcharge of 3.13% and 2.75%
(incl. GST) of the payment amount respectively when TPG debits the card.
Debit my Credit Card Card Type :
Visa Mastercard Amex Diners Club
Card Number
Name on Card
Expiry Date Verication Code
NOTE: For security purposes you are required to provide the Verication Code. The 3
digit number is located on the signature panel on the back of your Visa, Mastercard,
Diners Club.
On American Express, the 4 digit number is located at the front of the card above the
credit card number. Please write this number in the space provided.
Direct Debit my Account - Please ll in the Direct Debit form on
the following page.
If paying by Direct Debit please provide driver licence , proof of
age card number for age verication.
C
SIGNATURE
Name
TPG Username
Business Name
Address
Suburb/Town
State Post Code
Phone
Mobile
Email
Date of Birth
Signature
Existing Service Owner
A
( )
/ /
/ /
Date of issue: 25/10/16. Replaces: 30/08/16 Page 1 of 3