"Iridium Service Activation Request Form"
IRIDIUM® FLIGHT TRACKING ACTIVATION REQUEST Please return to Stratos: Attn. Sales Department Sales Contact, if known: ® THIS FORM SHOULD NOT BE USED FOR ANY OTHER IRIDIUM SERVICE ACTIVATION Check one box: Bethesda, Maryland Ottawa, Ontario St.Johns’, Newfoundland Weston, Florida Phone: +1 301 214 8800 Phone: +1 613 230 4544 Phone: +1 709 748 4233 Phone: +1 954 217 2256 Fax: +1 301 214 8801 Fax: +1 613 230 4212 Toll Free: 1 888 766 1313 Toll Free: 1 800 848 9660 Fax: +1 709 748 4300 Fax: +1 954 217 2272 Seattle, Washington London, England Asia-Pacific Phone: +1 206 633 5888 Phone: +44 20 7 562 4826 Phone: +852 2918 8250 Toll Free: 1 800 250 8962 Fax: +44 20 7 562 4884 Fax: +852 2918 9808 Fax: +1 206 633 5871 This form is used to register and/or activate Iridium satellite equipment and SIM card ("Equipment") for flight tracking services ("Services") with Stratos. Customers are required to complete ONLY the section and/or information pertaining to their chosen Equipment and Services option, then return the completed form to Stratos via facsimile at the applicable fax number. Upon activation of the Equipment and Services, Stratos will assign Customers with numbers for the selected additional services and include such numbers in Section C of this form. Stratos will then return this form back to the customer for their records. All new Customers must submit a completed Subscriber Application and Services Agreement, along with this completed form prior to the registration and/or activation of the Services. The Subscriber Application and Services Agreement are available from your authorized Stratos Dealer, your Stratos Account Manager, or on Stratos’ website at www.stratosglobal.com. Service activation requests from new customers that do not have a Subscriber Application and Services Agreement attached will be returned to the Customer. Activation of Equipment and Services is contingent upon Stratos’ review and approval of Customer’s Subscriber Application and Services Agreement and Stratos reserves the right to request additional credit information from Customer. PLEASE PRINT CLEARLY & COMPLETE ALL SECTIONS THAT APPLY SECTION A: CUSTOMER INFORMATION (Must be completed by Customer) Name: Date: Company Name (if applicable): Address: Telephone: Fax: Name of Retailer: IRIDIUM WORLD SATELLITE SERVICE INFORMATION (To be completed by Customer, if applicable) IMEI (15-digit serial # located on handset’s package) SIM Serial Number (19-digit serial number on reverse of SIM Card) IRIDIUM FLIGHT TRACKING INFORMATION (To be completed by Customer If, applicable) S200 or LMC Serial Number: (For commercial web access only) User Name: Aircraft Asset (Tail) Number: Password: Commercial Service W/ web access: SBD Destination addresses: email@example.com Yes □ No □ firstname.lastname@example.org AFF.GOV tracking: email@example.com Yes □ No □ firstname.lastname@example.org Page 1 of 2 Revised 1/26/06 IRIDIUM® FLIGHT TRACKING ACTIVATION REQUEST Please return to Stratos: Attn. Sales Department Sales Contact, if known: ® THIS FORM SHOULD NOT BE USED FOR ANY OTHER IRIDIUM SERVICE ACTIVATION SECTION B: SELECTED IRIDIUM SERVICE RATE PLAN (Must be completed by Customer) Additional Services: Voice only Flight Tracking (Recurring One (1) year contract, cancellation fee is $250) Voice and SBD Voice Mail Service SBD only Data Service Two-Stage Dialing Short Burst Data SECTION C: ASSIGNED IRIDIUM SERVICE NUMBERS (To be completed by Stratos) Iridium Satellite Service Phone #: MSISDN-C Data Service Number__________________________________________________________________________________ SECTION D: CUSTOMER SERVICE ACCEPTANCE (Must be completed by Customer) By signing below, I hereby certify that I am an authorized representative of the company ("Customer") and I agree that a facsimile copy of this form will be valid and binding for all purposes. I understand that the Services and/or Equipment requested herein will be provided by Stratos, except as otherwise specified by Stratos, pursuant to the applicable terms and conditions posted on Stratos' website at www.stratosglobal.com ("Terms") and at the prices provided to Customer by Stratos ("Prices"). Customer agrees to be bound by the Terms and Prices (each as amended by Stratos from time to time) applicable at the time of the provision of Services, unless Customer enters into a separate written agreement with Stratos for the Services. Accordingly, Customer's use of the Services will be subject to the terms and conditions, including price(s), of such agreement, when executed by both parties. Customer has been provided ample opportunity to review the Terms. Customer takes particular notice that the Terms include specific clauses, including but not limited to: (A) LIMITATION OF LIABILITY; (B) LIMITATION OF IMPLIED OR STATUTORY WARRANTIES; AND (C) INDEMNITY, HOLD HARMLESS, AND DEFENSE OF THE PARTIES, and herein certifies that such clauses have been brought to Customer's attention. CUSTOMER SIGNATURE: DATE: SECTION E: CUSTOMER VERTICAL MARKET (Must be completed by customer) MI Marine – Industrial GS Gas CN Construction MR Marine - Recreational AV Aviation FY Forestry GT Government RF Disaster Relief / Emergency Services RT Rental RC Recreation MG Mining OL Oil BT Business Traveler The pin code will default to 1111. Account will be activated and Iridium phone/pager numbers sent to the customer within 24 hours of credit approval Voice Customers Only. We encourage you to dial 6868 direct from the Iridium handset. Although this is not required to activate your service, you will reach a satellite operator who can confirm your connectivity and provide you with any needed assistance. This is a toll- free call from your Iridium handset. For any customer support issues regarding your Iridium Satellite Equipment and/or your Stratos airtime service, please contact Stratos Customer Care at: 1 877 578 7286 (within North America) +1 709 748 4212 (outside North America) 6868 (From your Iridium handset) email@example.com CSR ID: Request ID: Voice Contract #: Paging Contract # Sales Order #: Cust Acct: Time: Date: Page 2 of 2 Revised 1/26/06