WiFI Booking Form

Please complete the following fields to pre- book your WiFi vouchers.

WiFi vouchers can be used at our hotspot located at the West Island CRC (opposite the supermarket)

Please check with your accommodation provider who may provide their own internet, before pre-booking.

PLEASE NOTE THAT CREDIT CARD PAYMENT IS REQUIRED PRIOR TO DELIVERY OF VOUCHERS. PLEASE PHONE THESE DETAILS THROUGH TO US AFTER SUBMITTING. P: 08 9162 7707
UNPAID VOUCHERS WILL NOT BE DELIVERED.

First Name *

Last Name *

Company Name (if any)

Do you require a receipt to be emailed to you?

Yes pleaseNo thanks

Email Address

Contact Phone

Accommodation on Island (please ensure these details are correct) *

Date of arrival *

WiFi Requirements

1GB - $105 GB - $25 (recommended)

Number of each Voucher (you may need to contact us for different qtys) *

Total Amount Payable

How to pay?

To ensure your voucher is delivered prior to your arrival, please phone our office with your credit card details.
P: 08 9162 7707

Any comments?

IMPORTANT INFORMATION

The WiFi provided is ‘as is’ without warranties of any kind, either expressed or implied. Note that NBN is satellite fed on Cocos, and during heavy cloud periods the internet may drop out. The CRC is not responsible for the WiFi you have purchased.

Please check with your accommodation provider, who may provide their own internet.

We are unable to check your data use or offer refunds.

Signature - I HAVE READ THE IMPORTANT INFORMATION *

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OFFICE USE ONLY

Calendar reminderPayment madeReceipt IssuedWiFi delivered