TELSTRA ADVANCED SERVICES SERVICE REQUEST FORM

ADVANCED SERVICES – PAYG STEP 1: YOUR DETAILS (*INDICATES A MANDATORY FIELD) Send a completed copy of this service request form to your Telstra Representative who will assist you to finalise the details of your Advanced Services request. Note: To ensure we can provide Advanced Services to you, we need to minimise errors and eliminate ambiguity in this Application Form. Please ensure you: provide your contact details so we can contact you quickly if needed; ensure you complete all the mandatory fields to eliminate questions; and do not hand write any instructions or modifications on this Application Form as doing so will render this Application Form void.

CONTRACT DETAILS

Customer Name1* ("Customer", "you" or "your")
1Customer Name is the legal entity under which the Service(s) will be registered.

Customer Billing Details

Customer Billing Entity Name*
Billing Address*
Contact Name & Email Address*

STEP 2: Service Order Details

Note: To be eligible for this service you must have an existing Telstra Programmable service.

Service Overview

Customer Requested Date 2*
2This is not the Firm Delivery Date, which will be advised upon completion of the feasibility study.

SERVICE DETAILS

Please provide your TPN Domain ID:

TPN Domain ID

Advanced Services Type(s)

Please indicate the Advanced Services Type(s) you would like to request, you may pick more than one services:

☐ General Incremental TPN tenancy related changes - Topology building and resource resizing.

☐ VNF (Virtual Network Function) Configuration Changes - Router & firewall.

☐ Data Centre and Cloud Connectivity.

☐ Secure VPN - SSL and IPSEC tunneling.

☐ TPN setup with VNF Configuration - Base non MAC

☐ Other (If none of the above apply)

Click or tap here to enter text.

STEP 3: Customer Contact Information

Administrative Contact
Name
Direct Line (Work)	Email
Email Marketing2

STEP 4: Submission of the service request

By clicking the Submission button below, an email will be sent to our Advanced Services team with this form attached. Please enable your Microsoft Word macro in order to automate the auto send function. Otherwise, please email our Advanced Service team with the service request form attached, advancedservicespayg@telstracloudpremiumservices.zendesk.com