Sign up form

UBB Broadband Sign Up Form

Complete this form and our team will contact you back once they have assessed the options for your address.

Personal or business details

* Indicates required field

Name *

First

Last

Business name *

Account billing name *

Address for service *

Landline contact number *

Mobile number *

Email address *

Contract holder date of birth *

Contract holder drivers license number *

Service you require

Service *

Phone service *

House type *

Use of current providers mount & cable *

Property obstacles we need to be aware of *

Trees or hedges Out lying bulding's that potentially block LOS Other - please include in comments

Is removal or trimming of trees impeding LOS possible *

Important details about your homes that may impact your installation *

Is this a staff broadband connection? *

Yes No

Farm, dairy shed or property name *

House name/number for connection *

Ruralco details

Ruralco member *

Ruralco card name *

Ruralco number *

Business or personal card *