Now Sign-up Lead Submission. NOW Award Winning NZ Broadband Provider

Customer Lead Type

Retention

New

Moving

Mercury CA (contract Account)*

Customer Name*

Customer Address* Unit/Apartment Number, Street Number, Street Name, Suburb, City, Post Code

Contact Mobile Number* Format: 02X XXX XXXX

Customer Email Address*

Preferred Contract Length

12 months

24 months

Open Term

Customer Permission for NOW to Call*

Customer aware they will be contacted within 4 hours (8:30am-5pm, Mon-Fri)*

Mercury Agent Name* First name Last name

Mercury Agent Email Address* Please enter your Mercury email address

Additional Notes* Anything else NOW needs to know