Completed forms should be scanned and emailed to cellular.services@maine.edu

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: ______________________________@maine.edu

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