USCC Service Agreement by ojp65951


									USCC Service Agreement                                                                                                                                                              Page 1 of 2

                                                            New                      Extension                       COR                      Contract# M014139304917936

                            BILLING INFORMATION                              Individual                     Business                              Government
Billing Name (Please Print)                                                         I
                                                                                          Social Security Number                           Birth Date          Password
JEN'S DOG WALKERS                                                                   N                                                                          Beach
Billing Address                                                                     D     State                  Drivers License Number                        Expiration Date
1 S STATE STREET                                                                    V
Apt/Suite No.                                                                       I     Employer                                                             Position
City                                    State               Zip                     A     Business Address                      City                       State          Zip
CHICAGO                                 IL                  60603
Physical Address (If PO is listed above)                                                  Tax ID                BAN Group ID                         PO#           Exp Dt.
Apt/Suite No.                                                                             Billing Contact Name
                                                                                    U     JENNIFER FIELDSTONE
City                                   State               Zip                      S     Contact Phone                                                            Ext.
                                                                                    N     (312)487-5599
Home Phone                           Business Phone                                 E     Tax Exempt        Yes If yes, attach certificate. Certificate #:
INTERNAL USE ONLY                                                                            Business Guarantor paragraph on the Business Reference Sheet has been
  DL     SS#     Address                DOB          Saleperson Initials:_____          completed or if sole proprietorship, individual credit information has been provided.

                   Comp/Sales ID#:    Location ID#:         Does the customer have current service                                           Requested CTNs        Deposit Amount
                                                                                                            If yes, existing cellular #:
                   TN066              L223                  with U.S. Cellular ?  Yes         No                                             Approved #:           $100.00
 Dealer Use Only                                            Add service line to                                                               3
                                                           existing account ?     Yes         No
 CAS#                         Invoice Number    Cycle Close Date       Billing Account Number                 Activation Date     Cellular Telephone Number         Unlock Code
 LB-TEST00000242                                23                  820014139             Jul 26, 2006                            (828)208-3049
                                                              SERVICE INFORMATION AND CHARGES
                                                             INDIVIDUAL MONTHLY CHARGES AND SERVICES
Price Plan
Promotion Price Plan
# Minutes included in plan                             Peak__________________                            Off-Peak__________________

Included Data Usage                _______________________________
Additional Services (SOCS)

Total charges for additional services                                            *(See page 2 for Details)
Federal and/or State Universal Service Charge                                    (Subject to change without notice)
Total Individual Monthly Charges and Services
                                  ACCOUNT MONTHLY CHARGES AND SERVICES                                 BZW232003
Price Plan               BZW232003                WIDE AREA BizShare 3000                              1 to 2 Lines $129.99                                17 Lines $399.99
Promotion Price Plan
                                                                                                       3 Lines $139.99                                     18 Lines $419.99
# Minutes included in plan                 Peak__________________           Off-Peak__________________ 4 Lines $149.99                                     19 Lines $439.99
Additional Services (SOCS)                                                                             5 Lines $159.99                                     20 Lines $459.99
                                                                                                       6 Lines $179.99                                     21 Lines $479.99
                                                                                                       7 Lines $199.99                                     22 Lines $499.99
                                                                                                       8 Lines $219.99                                     23 Lines $519.99
                                                                                                       9 Lines $239.99                                     24 Lines $539.99
                                                                                                       10 Lines $259.99
Total charges for additional services                                                                  11 Lines $279.99
Federal and/or State Universal Service Charge                 (Subject to change without notice)       12 Lines $299.99
                                                                                                       13 Lines $319.99
Total Account Monthly Charges and Services
                                                                                                       14 Lines $339.99
                                                                                                       15 Lines $359.99
                                                                                                       16 Lines $379.99

You acknowledge receiving a copy of and agree to U.S. Cellular's Terms and Conditions of Agreement, attached hereto and made part of this agreement.

INITIAL TERM:      24   months      EARLY TERMINATION FEE: $___________

                                 PAYMENT INFORMATION                                                                               SIGNATURE
 $_________________ Cash                      $_________________      Check                        Authorized Customer Signature                                     Date
 $_________________ Gift Certificate          $_________________      CC                           X
   Visa                     MasterCard           AMEX                    Discover
 Credit Card# _______________________ Expiration Date: ______________                              Sales Representative / Agent Signature                            Date
By initialing here, customer authorizes company to charge future amounts due under this
service agreement to the credit card account listed above ______________                                            Thank you for selecting U.S. Cellular !

                                                                                                                                              Contract# M014139304917936

                                                              SERVICE INFORMATION AND CHARGES

http://mad1qwa4:8000/qwa4/usc_csaEF.jsp                                                                                                                                               7/5/2006
USCC Service Agreement                                                                                                                                               Page 2 of 2
                                INITIAL CHARGES
 Activation Fee                                                                                          Signal Dial Direct* Plus Insurance
 Advance Monthly Charge

 First Month's Prorated Minutes

 Security Deposit
                                                           $100.00                 [ ] Accept   ___________               [ ] Decline___________
 Equipment/Phone Charge (below)                                                    If You subscribe to Signal Dial Direct Plus Insurance, You acknowledge that the
 Equipment/Accessories (below)                                                     equipment listed here is in Your possession and in good working order.You
                                                                                   have received, read and understood the rates and terms and conditions under
 Installation Charge                                                               which the insurance is offered as outlined in the brochure.You acknowledge that
 Other (specify)                                                                   insurance protection is offered by the insurance company, and not by U.S.
                                                                                   Cellular. Requests for information for claims regarding the insurance will be
 Other (specify)                                                                   directed to Signal. A summary of coverage is available by calling 1-800-480-
 Other (specify)

 Other (specify)

                                                                       USER INFORMATION
User Name                                                             City                                                 State              Zip
MARY ROONEY                                                           CHICAGO                                              IL                 60603
User Address                                                                 Home Phone                Business Phone                   Lead Source Code
1 S STATE STREET                                                             (828)208-3049
List Other Authorized User(s)

                                                                   EQUIPMENT INFORMATION
ESN/MEID                            Item ID/Description                                                                                    Price
03000176522                         56128 - MO V710 CDMA TRMD 1XRTT GPS PH [ 88617GHBPA ]
(Check One)                       Sale                      Private                       Demo                      Loaner                         Upgrade
Accessory Description    QTY        LOC SITE         ITEM ID            PRICE       Accessory Description    QTY       LOC SITE          ITEM ID             PRICE

1.                                                                                 3.

2.                                                                                 4.

                                                       * Detailed Description of Additional Services (SOCs)

     SOC                 SERVICE               PRICE       EXPIRATION (if any)            SOC               SERVICE                PRICE       EXPIRATION (if any)

CD                 AIRTIME DETAIL
                  easyedge PIC MSG 50-
DTMMSBUI2                              $5.95
                  FREE INC
                  easyedge UNLIMITED
DTUNLB004                                  $9.95
                  WIDE AREA UNLMTD
                  CALL ME MINS
                  UNLIMITED MOBILE
                  TO MOBILE
RB2719002          100 ROAM MINUTES        $10.00

http://mad1qwa4:8000/qwa4/usc_csaEF.jsp                                                                                                                                7/5/2006

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