SPRINT RELAY STORE WIRELESS ORDER FORM FOR STATE OF UTAH
Customer Name: First Name Middle Initial Last Name
PICK A DEVICE YOU WISH TO PURCHASE—ONLY ONE PER ORDER FORM
BlackBerry Curve 8330
Free with written approval from Utah PSC
$29.99/mo Data Only Plan with 2-Year Service Agreement plus taxes and any add-on options.
TITANIUM
RED
BlackBerry 8830
Free with written approval from Utah PSC
$29.99/mo Data Only Plan with 2-Year Service Agreement plus taxes and any add-on options.
Sprint 30-Day Risk-Free Guarantee**
**minus all charges based on actual usage within 30 days.
Note: Only available through an authorized Sprint Relay representative or online at www.sprintrelaystore.com Not available at any Sprint retail store, Telesales, or online at www.sprint.com.
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Order Form: 2008-08-01
SPRINT RELAY STORE WIRELESS ORDER FORM FOR STATE OF UTAH
For Internal Use Only: Date Approved by Utah PSC: ___________________
Customer Name: First Name Shipping Address:
Middle Initial
Last Name
City: _______________________ Billing Address: City: _______________________ Email Address: Videophone or IP #: TTY or Work Phone #: __ __ __ — __ __ __ — __ __ __ __ Date of Birth: Social Security #: MM / DD / YYYY __ __ __ — __ __ — __ __ __ __
State: ________
Zipcode: _________
State: ________
Zipcode: _________
__ D-Link
__ VP-100/VP-200 Required
Required for credit check. Required for credit check. Exp Date: MM / DD / YYYY __ Discover
Driver’s License #: ______________________ Credit Card Type: Credit Card #: Expiration Date: __ Visa __ __ __ __
State Issued: _____
__ MasterCard __ __ __ __
__ American Express __ __ __ __ __ __ __ __ CVC/Security Code:
MM / DD / YYYY
__ __ __ __
Due to FCC mandate, we are required to obtain the following information from you to protect your account when you call for customer service or technical support: Please note: Your PIN # must be numerical, no letters. The PIN # cannot be in sequential order such as: 1234567890 or 1231231231. You cannot use your social security number, date of birth, or your Sprint wireless phone number.
Create your own 6 to 10 Digit PIN #: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Please pick one security question below, then fill in your answer:
Name of my first elementary school Name of the street I grew up on Name of the first company I worked for Make/Model of my first car Name of my first best friend when I was a kid My favorite hobby ANSWER:
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Order Form: 2008-08-01
SPRINT RELAY STORE WIRELESS ORDER FORM FOR STATE OF UTAH
Customer Name: First Name DATA ONLY PLAN: 2-Year Plan includes: ! ! ! ! ! ! ! Unlimited email service $29.99/month Unlimited internet access Unlimited instant messaging Unlimited domestic SMS/Text Messaging (Included! Save $15.00!) Unlimited Phone As Modem (PAM) (Included! Save $15.00!) 20¢ per minute for local voice phone calls or 40¢ per minute for LD voice phone calls Both Incoming/Outgoing calls will be blocked, you can contact us to remove the block Your initials here: ___ N/A $ 7.00/month Middle Initial Last Name
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One time $36 activation fee will be included on your first bill from Sprint: Insurance: Your initials here: _____ Your initials here: _____ No, thanks. Total Equipment Protection
Insurance is highly recommended. Without it, you may have to purchase a new phone at retail price if your phone is damaged, lost, or stolen. DEPOSIT: You may be required to leave a deposit for each phone based on your credit check. If all monthly payments to Sprint are received on time, the deposit will be returned in 12 months. If you select “None”, you will not get your device if our system shows that you are required to pay a deposit first. I approve a deposit if needed: _____ None _____ $100 _____ $150
Your initials here: _____ This indicates that I understand that Sprint will perform a credit check. MAILING LIST: Sprint Relay may email you regarding products and services that we think may be of interest to you. You can opt-out at anytime. ____ Yes, please add me to the mailing list. ____ No, thanks. What is your preferred BlackBerry email address? First choice: Second choice: Third choice: ________________________________@sprint.blackberry.net ________________________________@sprint.blackberry.net ________________________________@sprint.blackberry.net
SIGNATURE: ___________________________ TODAY’S DATE: ________________
Mail this completed order form with original and signed approval letter from State of Utah PSC to: Sprint Relay Store: Ken Goulston Sales Executive Sprint Relay Store - www.sprintrelaystore.com 866 948 0495 FAX Email- Kenneth.a.goulston@sprint.com
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Order Form: 2008-08-01