Payment Assistance Application Form

IMPORTANT: Please respond to all questions on this form. After submitting your application, we will contact you to discuss your request and gather further information depending on the option(s) you selected. For more details about our process for financial hardship requests, please refer to our Payment Assistance Policy available on our Financial Hardship page and the Policies page of our website.

Name*

Email*

Name of Authorised Representative (if applicable)

Account Number

Reason for Financial Hardship Assistance*

Assistance Options

Payment Extension
“I need more time to pay my current bill. I can make full payment by: ___/___ /___ “
Note: We do not allow payment extensions beyond the due date of your next bill. If you need a longer extension, please select a payment plan.

Alternate Payment Schedule
“It would help me to split my ongoing bills into smaller, equal payments each: Week/Fortnight”

Make Payments in Advance
“I would like to make an advance payment of $___ to cover future bills.”

Payment Plan
“I would like to change the due date of my monthly bill to: __ (preferred date).”

Change My Monthly Bill Due Date
“To pay back my current Go Troppo debt, in addition to my ongoing monthly plan fees, I can afford to pay back a maximum of $___ per: Week/Fortnight/Month”

Assistance Options

For more information about each assistance option, please refer to our Payment Assistance Policy.

Week

Month

Week

Fortnight

Month

During my payment plan, I understand that I still need to pay future invoices for ongoing monthly plan fees by the due date. If you have debt you cannot pay off through an extension (Option 1), you will need to set up a payment plan.

If you are not already on the lowest plan type(s) for your service(s), moving to a lower plan may reduce your monthly fees.
Would you be willing to move to a lower, cheaper plan if this option is available?

Yes

Privacy Collection Notice

The personal information we collect from you via this form will be used to assess and manage your request and provide you with assistance. By submitting this form, you confirm that you have read the Go Troppo Privacy Policy (available on the Policies page of our website) and consent to the collection, use, and disclosure of your personal information by Go Troppo for this purpose and any other purposes outlined in our Privacy Policy.

Assistance Options

Ready to Go Troppo?