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BELL ATLANTIC MOBILE NATIONAL ACCOUNTS_CELLULAR ACTIVATION REQUEST

By Irene Mcdonald,2014-07-01 11:02
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BELL ATLANTIC MOBILE NATIONAL ACCOUNTS_CELLULAR ACTIVATION REQUEST

     Agencies please complete the following sections: 1. Agency Address 4. Billing Information (for equipment) 2. Shipping Address 5. Authorized Signer 3. Billing Address (only if different from Agency Address ) Federal Account Order Form

    Activation Sales Representative: EDWARD ORIUWA Sales ID/ Billing System/Outlet ID:

    E Number#: Upgrade Mobile Number: 240-687-1744 VISION East (NE Area) - Outlet ID 3812-01

    EJ627 Other: Fax Number: 240-568-1993 ACE# EWI Profile I.D. (Mandatory for Navy CNI): 131996 extended profile

    Orders will not be processed unless a “Government Contract Type” is selected! Government Contract Type: GSA-Federal Supply Schedule - 19%

    Purchase Order #:

1. Agency Address: 2. Shipping Address: (No P.O. Boxes)

    Name of Agency: Name of Agency: doc/noaa/NA02ACT65006 P.O. Box: Street Address: 1315 EAST WEST HWY CIO/OPS2 Street Address: Building / Suite #: ROOM 9846

    Building / Suite #: City / State / Zip: SILVER SPRING, MD 20910 City / State / Zip: Attention: DIANA TOWNSEND

    Attention: Phone #: 3017133330 X 208

    Phone #: *Check here if same as billing address: 3. Billing Address: (Complete only if different from Agency Address) *Check here if same as Agency Address above Agency Name / Address / P.O. Box:

    Equipment Bill of Sale: Equipment Billing Information

    (Choose One) Qty: Product: DYMAX Reason Code: Unit Price: 1. Purchase Order #:

    Code: Price:

    1 AIRCARD V620 72-Contracted Pricing $0.00 $0.00 2. Bill to Acct #: 518272523-00001

     Select One: $ $ 3. Credit Card Information (if applicable)

     Select One: $ $ Name of Agency:

     Select One: $ $ Name on Credit Card:

     Select One: $ $ Credit Card Type: Select One:

     Select One: $ $ Credit Card #:

     Select One: $ $ Expiration Date:

     Select One: $ $ Amount to be Billed to Credit Card: $

     Select One: $ $ Date of Price Quote:

     Select One: $ $ Signature:

     Select One: $ $ Printed Name:

     Select One: $ $ Phone #: Date:

     Select One: $ $ Select One: $ $

     Select One: $ $

     Select One: $ $

     Select One: $ $

    Account # Add to existing Create New Group ID/Tie Code IBAS MAC Code Division/Hierarchy Info

     518272523-00001 FSDOC

    MobileWeb Enhanced Features Text Messaging Other: Other: Other: Rate: Rate: Rate: Rate: Rate:

Comments: BILL TO ACCOUNT 518272523-00001

    Date: 5. Authorization Signature:

    041505

    Email this form to Outlook email address “Federal Acct Orders” or FAX directly to 866-873-1929

    Mobile # ESN Activation Price Plan Monthly Promo Model User Name (Desired or # Access Code/ NPA-NXX) Upgrade BGSA

     1. 3017879296 Activation 53575 $79.99 504 V620 NOT SPECIFIED

     2. Select One:

     3. Select One:

     4. Select One: 5. Select One: 6. Select One: 7. Select One: 8. Select One:

     9. Select One:

     10. Select One:

     11. Select One:

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     14. Select One: 15. Select One: 16. Select One: 17. Select One: 18. Select One: 19. Select One: 20. Select One: 21. Select One: 22. Select One: 23. Select One: 24. Select One: 25. Select One: 26. Select One: 27. Select One: 28. Select One: 29. Select One: 30. Select One: 31. Select One: 32. Select One: 33. Select One: 34. Select One: 35. Select One: 36. Select One: 37. Select One: 38. Select One: 39. Select One: 40. Select One: 41. Select One: 42. Select One: 43. Select One: 44. Select One: 45. Select One: 46. Select One: 47. Select One: 48. Select One: 49. Select One: 50. Select One:

    Email this form to Outlook email address “Federal Acct Orders” or FAX directly to 866-873-1929

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