Request edit access
Report a Fixed Line Fault (internet or landline)
You MUST have tried to solve your issue first before completing this form.
It is essential that you have a ticket or fault number from your provider.

Please ensure you have your correct address (including locality) before filling in this form.

BIRRR has several tips about maximising your internet service on our website here: www.birrraus.com

What type of technology do you have a fault with? *
Required
Account FIRST Name *
Please use the name listed on the account in question.
Your answer
Account LAST Name *
Please use the name listed on the account in question.
Your answer
If it is an ADSL or landline fault, what is the landline number? Type NO if it is NBN Fixed Line *
Your answer
Address *
Please type Address in this formation - 935 Tipton Street Surbiton QLD 4724
Your answer
State/Territory *
Required
Contact Phone number, that you can be called on to discuss the problem. *
Your answer
Contact email address *
Your answer
Can you be contacted on Facebook?
Leave blank if no, type your Facebook contact name if yes.
Your answer
Please state your provider *
Please note BIRRR may be able to contact your provider on your behalf.
Your answer
Please provide your fault reference or ticket number *
Your answer
When did your issue / fault start ?
Your answer
Please state your issue giving as much detail as possible.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service