Konnekt-Telstra Captioning Videophone Program

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Lead source description
Form ID: 106, Form name: Konnekt-Telstra Captioning Videophone Program Agreement, Post/page ID: 10206, Post/page title: Konnekt-Telstra Captioning Videophone Program Agreement, Date (dmy): 29/05/2022, User IP address: 100.24.115.215, HTTP Referrer URL:
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City State / Province / Region Country
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Participation Agreement

The Konnekt-Telstra Captioning Videophone Program seeks to help Australians who have a severe or profound hearing impairment to stay connected.

This Program is available to customers already connected on one of Telstra’s phone networks.
Captioning Videophone User
Name of user
First Last
Residential address
Street Address Address Line 2 Suburb / Town State Postcode
Home phone number (if any)
Mobile (for text) (if any)
Work phone (if any)
Email Address (if any)
Current devices
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Existing Internet service
- Unknown - Please contact me regarding Internet
- None, I have Telstra NBN voice only - please help me upgrade to Telstra NBN voice and data
- None, I have a Telstra mobile phone service only - please supply Konnekt-managed mobile Internet
- NBN Internet (data is already included in my plan)
- Mobile Internet via my phone or tablet (unsuitable) - please supply Konnekt-managed mobile Internet
- Mobile Internet via always-on 4G modem (suitable)
- Other Internet
Existing Internet
Why my current device or regular phone is unsuitable
Telstra Account Details
Telstra or Belong phone number
From pages 1 and 2 of your Telstra bill
- See my full details below
- I will supply some details later
- I am a Belong customer
Telstra account number
Monthly plan amount
Plan name
Additional Contact Person

(If it is easier for us to talk to someone you nominate)
Contact name
First Last
Phone
Email
Equipment Delivery
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Deliver to
- User
- Additional Contact Person
- Other
Contact name for delivery
Phone for delivery
Street address for courier
Street Address Address Line 2 Suburb / Town State Postcode
Instructions for courier
Conditions

All 5 check boxes must be ticked
Condition 1 - Details are accurate and correct*
- I acknowledge that the details provided for the Captioning Videophone User are accurate and correct, and there is a need for the Captioning Videophone User to participate in the program.
Condition 2 - Program end and equipment care and return*
- I acknowledge that the Program may be ended at our discretion with at least 6 months notice in writing. I agree to take care of the equipment and return it if requested at the end of the Program or when my participation ends.
Condition 3 - Agree to stay a Telstra customer*
- I agree that I must stay a Telstra or Belong customer to remain eligible for the program. This does not include any other Telstra services that may be provided to me through the Konnekt-Telstra program.
Condition 4 - Agree to Program fee*
- I agree to pay Konnekt the Program Fee of $10 per month, or $5 per month if I already have a suitable Internet service, during my participation unless otherwise agreed with Konnekt. I understand that if I currently have no compatible Internet service then Konnekt will assist me financially with a suitable Telstra Internet service.
Condition 5 - Feedback to Konnekt*
- I agree that during the Program I may be asked to provide feedback to Konnekt in relation to the Konnekt service.
Privacy policy: konnekt.com.au/privacy Konnekt will only release the above information:
- To Konnekt staff or contractors for purposes of equipment supply, connection, billing, on-going support, return, and to ask you about the Program to help us improve the Program; or
- If we are required by law, or if required to obtain legal or accounting advice.
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Legacy section with unused fields
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Mounting Option - No additional cost
- Table/bracket included.
- None (no table or bracket)
- Side table (timber colour)
- Side table (white)
- Side table (black)
- Wall-mount bracket, slim-line
- Wall-mount bracket, pan-tilt
Options
Heading field, hidden, for Installation options
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Installation options
- Only required for wall-mount (Videophone comes completely set up and personalized). Installation is available in most Australian metro/city centres.
- Professional installation (Australia) AUD:
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Phone number
- A phone number for Videophone that your contacts can dial, on which to receive regular incoming phone calls. Please specify the area code.
- Australia 02 (NSW)
- Australia 02 6 (ACT)
- Australia 03 (VIC, TAS)
- Australia 07 (QLD)
- Australia 08 (WA, SA, NT)
Extras (per mth)
Hidden Extras field under which to list the Call Options.
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Payment Details
Payment method
- Credit card or debit card
- Electronic invoice I can pay by card or Paypal
- Please contact me later about available payment options
I prefer to pay
- Month-by-month
- Every 3 months
- Every 6 months
- Annually
Payer name
First Last
Name on card
Card type
Card number
Expiry
CVC
Payer phone number
Payer email
Form Submission
This form is being submitted by
- The Captioning Videophone user
- An authorized representative
Authorized Representative
Authorized representative name
First Last
Relationship with user
Email address (for verification)
After you submit, Konnekt will immediately send you an email summary of your application. You must reply to our email to verify the submitter's email address.
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What They Will buy Section
Incomplete and currently unused section because the decision about $5 vs $10, and KMM vs BYO vs Upgrade Telstra plan, can't be made until after a discussion or requesting the Telstra bill.
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Order Date - dd/mm/yyyy
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Payment Status text Part 1
Captioning: Telstra Program Participant TRIAL/SERVICE COMMENCEMENT DATE = dd-mmm-yyyy (fill in after Videophone is operational) PAYMENT STATUS .... DATE PAYMENT RECEIVED: N/A (date to be filled on ONLY by Konnekt Accounts) PROCEED WITHOUT PAYMENT: N/A (it's Yes only if KG or JN approve, eg. sale to Aged Care facility which pays on 30 days) REFERRAL PARTNER: N/A or Account: (who gets a commission from this sale): ...
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Payment Status text Part 2
. Description of Deal: (what deal has been struck) eg. XYZ gets 20% of the Purchase price, if customer proceeds to Purchase Amount: (amount the Account above will be receiving): eg. $200 inc GST Date Paid: (to be filled in ONLY by Konnekt Accounts): dd-mmm-yyyy
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Once-off payment text
. ONCE OFF PAYMENTS: (Billed to Telstra) ....$1,290 Captioning Videophone bundle ....$0 Delivery within Australia (waived; covered under Telstra agreement). ....$0 Self-install. ....$82.50 USB Handset ? ....$350 Wireless Access Button? ....$175.70 TP-Link TL-MR6400 modem? ....$38.50 Bracket, pan-tilt (Mounting Dream)? ....$57.20 Bracket, extendable Arm (North Bayou)? ....$31.90 Side table? ....$44.00 Powered External Speaker? MONTHLY FEES (Billed to the customer) ....
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$5 fee text
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$10 fee text
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Monthly Fees Telstra part 1
. MONTHLY FEES (Billed to Telstra): ....$44.90 / mth Monthly Fee
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Monthly Fees Telstra part 2
. ....$xx.xx + 10% / mth Telstra Internet Subsidy (see below)
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Monthly Fees Telstra part 3
. ....COST + 10% / mth Monthly cost of Skype Number, Skype Subscriptions, Skype Credit (en masse, across Program)
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Monthly Fees Telstra part 4
. ....COST + 10% / mth Telstra Mobile Broadband
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Internet subsidy yes
. TELSTRA INTERNET SUBSIDY (our costs - paid into customer Telstra Account) ....$xx.xx per month, calculated as follows .... .... Old Plan = eg. Telstra NBN Voice Essentials $35/mth .... New Plan = eg. Telstra NBN Voice Plus Data 500GB 25/5 $75 ....New Telstra Account Details: .... Account Number 2000 xxxxx xxxx .... Account Name = .... Account Address = .... Account Telstra Phone Number = ....Pay using recurring BPAY .... .... Biller Code 23796 .... Reference Code = Account Number above
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Internet subsidy no
. TELSTRA INTERNET SUBSIDY (our costs - paid into customer Telstra Account) ....None
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Skype subscription text
. SKYPE SUBSCRIPTION(s) (our costs): *** USE TELSTRA SKYPE MANAGER *** ....$28.05/mth Aust Unlimited MOBILES and landlines. ....$9.02/mth Skype Number Australia +61 x xxxx xxxx. ....Skype Credit auto-recharge setting: Lower limit $4, recharge amount $5, max mth recharge $200
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Konnekt Mobile Internet yes
. KONNEKT SUPPLIED Telstra Business PREPAID SIM (our cost): ....Konnekt Account = 2465 2776 93 ....mobileXXXX@konnekt.com.au ....Telstra Mobile Plan (allows call forwarding and CLI) 40GB/month $55.00 ....Telstra Tablet Data Plan (no call forwarding possible) 20GB/month $25.00 ....SIM = xxxxxxxxxxxxx Mobile Number = 04xx xxx xxx
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Konnekt Mobile Internet no
. KONNEKT SUPPLIED PREPAID SIM (our cost): ....None
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Last WTB text with modem
. OTHER STUFF INCLUDED: ....Cat-6 LAN Cable 3m (MANDATORY unless customer is sure about Wi-Fi) ....Adhesive Clamps x 2 ? ....USB Handset (Currently MANDATORY for Program participants) ....Powered External Speaker ? ....TP-Link TL-MR6400 modem ? YES. ....Side table: Ikea, Oak / White / Black ? ....Bracket: Mounting Dream tilt/pan / North Bayou extendable arm ? ....Adhesive Clamps x 2 ....Do Not Turn Off Stickers x 2 ? ....Wireless Access Button ? ....5m Extension Cable ? CUSTOM CONFIGURATIONS TO BE DONE: WiFi Auto Connect ? Disable Pwr Button ? Blank Overnight: XXpm - YYam ? Setup Ability Switch: XKeys / Spectronics ? IFTTT / buzzer / lights ? (Captioning): Skype Number as CLI (*recommended*)? (Captioning): Mobile number CLI and Call Forwarding to Skype Number? ANY OTHER SPECIAL CUSTOM STUFF TO IMPLEMENT ?
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Last WTB text without modem
. OTHER STUFF INCLUDED: ....Cat-6 LAN Cable 3m (MANDATORY unless customer is sure about Wi-Fi) ....Adhesive Clamps x 2 ? ....USB Handset (Currently MANDATORY for Program participants) ....Powered External Speaker ? ....TP-Link TL-MR6400 modem ? ....Side table: Ikea, Oak / White / Black ? ....Bracket: Mounting Dream tilt/pan / North Bayou extendable arm ? ....Adhesive Clamps x 2 ....Do Not Turn Off Stickers x 2 ? ....Wireless Access Button ? ....5m Extension Cable ? CUSTOM CONFIGURATIONS TO BE DONE: WiFi Auto Connect ? Disable Pwr Button ? Blank Overnight: XXpm - YYam ? Setup Ability Switch: XKeys / Spectronics ? IFTTT / buzzer / lights ? (Captioning): Skype Number as CLI (*recommended*)? (Captioning): Mobile number CLI and Call Forwarding to Skype Number? ANY OTHER SPECIAL CUSTOM STUFF TO IMPLEMENT ?
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Comments about WTWB
Heading: WHAT THEY BOUGHT {} {} (1. Captioning: Telstra Program participant) Description (body): {219} {173}{221}{185}{281}{282}{183}{283}{284}{285}{184}{286}{188}{189}{287}{190}{288}

Konnekt-Telstra Captioning Videophone Program

Participation Agreement

The Konnekt-Telstra Captioning Videophone Program seeks to help Australians who have a severe or profound hearing impairment to stay connected.

Captioning Videophone User

Telstra Account Details

Additional Contact Person

Equipment Delivery

Conditions

Legacy section with unused fields

Section with used fields

Payment Details

Form Submission

Authorized Representative

What They Will buy Section

Comments about WTWB