Porting Form 1 Account Holder2 Address Details3 Porting Service4 Agreement Business Name (if applicable)Name* Title Mr.Mrs.MissMs.Dr.Prof.Rev. Given Name Surname Address* Unit No./Street No. Street Name Suburb State Postcode Email* Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Other Contact Number*Fax Number Harbour ISP CommunicationsI wish to port the following services to Harbour ISPOr I wish to port the following range of telephone numbers to Harbour ISPI wish to port the following services to Harbour ISP*Cat A: minimum 6 business days, Cat C: minimum 23 business days. If you do not provided a custover date then it is assumed to be required as soon as possible Click here for more details on Cat A and Cat CTelephone NumberCat A or Cat CCurrent CarrierIf Other - please type current carrierCurrent Carrier's Account Number TelstraOptusAAPTPowertelVerizonSymbioGotalkPrimusSoul/TPGiiNetIntermodeMyRepublicCommanderSpintelOther I wish to port the following range of telephone numbers to Harbour ISP*First no. in rangeLast no. in rangeCurrent CarrierCurrent Carrier's Account Number Preferred cutover date Preferred cutover time HH : MM AM PM Agreements* I authorise for the telephone number(s) listed above to be ported to Harbour ISP's Telephony Wholesaler. I acknowledge that I am authorised to request the porting of the telephone number(s) listed on this form I acknowledge that I have read and understood the HISP Porting Terms and Conditions I acknowledge that I have been advised of porting agreements By signing I have read and understood the HISP Number Porting Price List and understand that if my port is rejected by my carrier for what ever reason (eg I requested a Cat A and my carrier determins it is a Cat C) then further costs may be applied.Please refer to the HISP Number porting price list for a full list of pricingVerificationThis Customer Authorisation is valid for 90 calendar days from this date.PhoneThis field is for validation purposes and should be left unchanged.