AMENDED STATE OF WISCONSIN RATE PLAN

State of Wisconsin

• 
  Bill to address.
  
• 
  Ship to address or contact person.
  
• 
  Existing account number or mobile number if adding new lines.
  

1. 
   A Cellular Authorization Form signed by a purchasing agent, telecommunications manager or other authorized signer.
   

• 
  Agencies may use the bill to airtime account procedure (when purchasing equipment or accessories), if the Cellular Authorization Form states that is the preference. Please include the cellular account number or mobile number that items are to be billed to.
  

• 
  State Purchasing Cards are accepted with the Cellular Authorization Form. CellularOneAuthorizationForm
  

• 
  Authorization letters, other than the Cellular Authorization Form, will be accepted provided they contain agency name, bill to address, name of individual picking up items and account number or mobile number and they are signed by a purchasing agent, telecommunications manager or other authorized signer.
  

Date:      

Purchase Order No.      

ADD-ON  UPGD 

BILL TO ADDRESS:
Agency:      

ATTN:      

Address:      

Address 2      

City, St,:      

Zip:      

PHYSICAL ADDRESS:
Agency:      

ATTN:      

Address:      

Address 2      

City, St,:      

Zip:      

SHIP TO ADDRESS:
Agency:      

ATTN:      

Address:      

Address 2      

City, St,:      
Zip:      

 RATE: $9.75/mo., .12/min. – includes 30 minutes OR, OTHER PLAN:     
 USING CUSTOMER OWNED PHONE - (ESN)      




USER NAME OR DEPT:      



 BASIC EQUIPMENT PACKAGE (Motorola V120, carrying case, headset, battery, AC & DC adapters) OR,

OTHER PHONE - DESCRIPTION:      

ITEM ID:      

PRICE:      

PHONE TOTAL:      




ACCY TOTAL:      




ORDER TTL:      

CHG TO MO. BILL  INVOICE TO PO NO.  PURCH. CARD      
COMMENTS:      

Name of Telecommunications Manager, Purchasing Agent or Authorized Contract Signer

X      PHONE: DATE:     
Email or Fax to Dawn Burlingame, Executive Account Administrator, CellularOne, 2741 N. Clairemont Ave., Ste. C, Eau Claire, WI 54701, dawn.burlingame@dobson.net, fax 715-833-8856.

1. 
   A purchase order or P-card number and Cellular Authorization Form with the following
   

• 
  Bill to address.
  
• 
  Ship to address and contact person.
  
• 
  Existing account number or mobile number if adding new lines.
  

2. 
   A Cellular Authorization Form signed by a purchasing agent, telecommunications manager or other authorized signer.
   

• 
  Agencies may use the bill to airtime account procedure except on first order (when purchasing equipment or accessories), if the Cellular Authorization Form states that is the preference. Please include the cellular airtime account number and mobile number that items are to be billed to.
  

• 
  State Purchasing Cards are accepted with the Cellular Authorization Form
  

• 
  Authorization letters, other than the Cellular Authorization Form, will be accepted provided they contain agency name, bill to address, name of individual picking up items and account number or mobile number and they are signed by a purchasing agent, telecommunications manager or other authorized signer.
  

Date:      

Purchase Order No.      

ADD-ON  UPGD 

BILL TO ADDRESS:
Agency:      

ATTN:      

Address:      

Address 2      

City, St,:      

Zip:      

PHYSICAL ADDRESS:
Agency:      

ATTN:      

Address:      

Address 2      

City, St,:      

Zip:      

SHIP TO ADDRESS:
Agency:      

ATTN:      

Address:      

Address 2      

City, St,:      
Zip:      

 RATE: $6.95/mo., .10/min. OR, OTHER PLAN:     




 USING CUSTOMER OWNED PHONE - (ESN)      




USER NAME OR DEPT:      



 BASIC EQUIPMENT PACKAGE (Nokia 6340i, carrying case, headset, battery, AC & DC adapters) OR,

OTHER PHONE - DESCRIPTION:      

ITEM ID:      

PRICE:      

PHONE TOTAL:      




ACCY TOTAL:      




ORDER TTL:      

CHG TO MO. BILL  INVOICE TO PO NO.  PURCH. CARD      
COMMENTS:      

Name of Telecommunications Manager, Purchasing Agent or Authorized Contract Signer

X      

Phone:     

Date: