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ID:34347588
大小:56.50 KB
页数:3页
时间:2019-03-05
《activation information:激活信息》由会员上传分享,免费在线阅读,更多相关内容在应用文档-天天文库。
1、CustomerApplicationandAgreementACTIVATIONINFORMATION(FORUSEBYQUALTEX)Date#ofLinesNewCDMAWireless#:____________________________BILLINGINFORMATIONCONSUMERBUSINESSPartyFinanciallyResponsibleforAccount–Name(PleasePrint)HomeAddress*CompanyName/Responsible
2、Party(PleasePrint)CityStateZIPCodeContactName(AuthorizedBusinessContact)MailingAddress(ifdifferent)Address*CityStateZIPCodeCityStateZIPCodeBusinessPhone(____)YrsinBusinessFederalTaxID#HomePhone(____)Work/AlternatePhone(____)BankAccountInformation(Mon
3、thlyFeestobeElectronicallyDebited)Routing#:___________________________Account#:_______________________________________SocialSecurity#DateofBirth*PlaceofPrimaryUse–____Yes____NoThehomeorbusinessaddressindicatedaboveisforthepersonusingthephoneandisthep
4、erson’sresidentialstreetorprimarybusinessstreetaddress.TERM/FINANCIALRESPONSIBILITY&CUSTOMERACCEPTANCEInitialsOne(1)Year($________permonthplusapplicabletaxes)BYSIGNINGTHISFORMYOU’REAGREEINGTOTHEATTACHEDCUSTOMERAGREEMENTANDTOBEPERSONALLYRESPONSIBLEFOR
5、PAYMENTOFALLCHARGESASSOCIATEDWITHTHISACCOUNT.PLEASEREADTHEAGREEMENT.THECUSTOMERAGREEMENTSETSYOURANDOURRIGHTSCONCERNINGPAYMENTS,CREDITS,CHARGES,STARTINGANDENDINGSERVICE,LOCALNUMBERPORTABILITY,EARLYTERMINATIONFEE$175,LIMITATIONSOFLIABILITY,ANDOTHERIMPO
6、RTANTTOPICS.BYSIGNINGTHISFORMYOUAREAUTHORIZINGUSTOINVESTIGATEYOURCREDITHISTORYANDSHARECREDITINFORMATIONABOUTYOUWITHCREDITREPORTINGAGENCIES.WECANCONTACTANYOFTHEREFERENCESYOULISTED.BYSIGNINGITYOUAREREPRESENTINGTHATALLINFORMATIONYOUPROVIDEDISACCURATE.WE
7、ARERELYINGONTHATINFORMATION.ACOPYORFAXOFTHISFORMWITHYOURSIGNATUREISTHESAMEASTHEORIGINAL.CustomerSignature_________________________PrintName_____________________________________Date________INITIAL________CUSTOMERAGREEMENT§YourRightsToChangeOrEndYourSe
8、rvice;TerminationFees;PhoneNumberPortability–Exceptasexplicitlypermittedbythisagreement,you’reagreeingtomaintainservicewithusforyourminimumtermplusanyadditionaltimerequiredbyanypromotionsyouaccept.(Periodsofsuspensionofservicedon’tcounttowardthesereq
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