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Completed forms should be scanned and emailed to [email protected] CELLULAR PHONE ORDER FORM Device User: (Please print clearly) First name: __________________________________________ Last name: __________________________________________ Today’s Date: _______________ Department Name: _________________________ Office Phone: __ __ __ - __ __ __ __ Campus: (Please Check) ⃝ UMA ⃝ UMF ⃝ UMFK ⃝ UM ⃝ UMM ⃝ UMPI ⃝ USM Ship to Address: (Except USM users) Street:________________________________________ City:__________________________________________ State/Zip: _____________________________________ Dept. Billing Representative Name: _____________________________________________ Email: [email protected] Device: (Include Manufacturer, Model, Storage (GB), Color) Price: (See Administrator for pricing) ⃝ Local $3.50/month - $.03/min ⃝ National $7.50/month - $.03/min ⃝ $15/month -$.03/min ⃝ $.05/min pay as you go ⃝ Unlimited ⃝ Smart Phone *User Signature: _______________________________ *Dept. Approver Name: __________________________ *Dept. Approver Signature: ________________________ *REQUIRED: This form must be signed and approved by authorized department purchaser CHARTFIELD INFO FOR MONTHLY BILLING: Dept. Code Default Acct. Class Fund Program Code Project Code Op Unit All plans and/or devices are for University departments and are for business use only. For more information on proper mobile phone and device use see APL-VII at http://www.maine.edu/pdf/VII- DCellularTelphone.pdf. By signing this form you are agreeing to the appropriate use stated in APL-VII. For more information contact Brenda Kane at 780-4945 Today’s Date: ____/_____/_____ __ __ __ __ __ __ __ - 6 4 0 0 1 - __ __ - __ __ - __ __ __ __ __ - __ __ __ __ __ __ __ - __ __ __ ⃝ 2GB Data ⃝ 5GB Data ⃝ Unlimited Service Provider & Plan: (please check) ⃝ AT&T ⃝ Verizon (Select plan) ⃝ 400 shared ⃝ 600 shared ⃝ US Cellular (Select plan) ⃝ Unlimited Request type: (Please check) ⃝ New activation Cell number: __ __ __ - __ __ __ - __ __ __ __ ⃝ Upgrade ⃝ Cancellation ⃝ 1000 shared ⃝ Basic Flip Phone
