HomeMy Public PortalAboutAT&TAT&T Wireless Services
2020 224th St. SE
Bothell, WA 98021 Wireless IP Service Account
Phone: 800 552-3373
Fax: 425-288-4199 woo Gwaoaent Form F04Z Revision 11/15/99
Note: To use this form online, tab or arrow -key between fields: press the space bar to check boxes.
Check all boxes that apply.
Date Service Required: PO Number.
® New Government Account
❑ Add-on Existing/Change to Existing Account No.:
Total NEls Requested (at this time): 2
ACCOUNT•-
Company Name: Gulf Stream Police Department
Technical Contact Name: Chief Garrett J. Ward
Attn: Chief Garrett J. Ward
Phone No.: 561278-8611 561704-4127
Company Billing Address: Gulf Stream Police Department
e-mail address: gward@gulf-stream.org
246 Sea Road
Federal Tax ID # / SSN:
City: Gulf Stream State: FL
Authorized Requesters: Lt. Edward Allen
Zip: 39483 —
(for adding future NEls) Lt. Edward Allen
Phone No.: 561278-8611 5617134-4127
Fixed Connection:
Contract Tenn:
❑ Internet ® Frame ❑ Leased ❑ Dial Out
® 1 year, ❑ 2 years, ❑ 3 years, ❑ 4 years, ❑ 5 years
Relay Line Gateway
Voice Rep Name:
Data Rep Name:
Voice Rep Code: Phone:
Data Rep Code: Phone:
Data Dealer/Channel Name
Data Dealar/Channel Code Phone
EQUIPMENT••
Primary User.
Rate Plan Name: GTU
Primary Service Address:
Mo. Fee: $49 Usage Included: Unlimited
Activation Fee: $0 Promotion Code:
Feature Code:
City: State:
Modem Manuf.: Sierra Wireless
ZIP: —
Model: Aircard 350 EID: 00-AO•D5-02-6A-7E
Primary User Phone No.:
PocketNet Custom Homedeck? ❑ Yes ❑ No
PocketNet Cell No.:
Homedeck Name:
Internet Secured Feature? ❑ Yes, one time $25 fee ® No
Office use only:
NEI: DSN:
A/C:
Signature:
Name (print):
Accepted:
AT&T Wireless Services, c.
Signature: ,
Name (print): Garrett J. War
Date:
Title:
Date: a /S A
Title: Chief of Police
EQUIPMENT AND SERVICE
INFORMATION
Primary User:
Rate Plan Name: GTU
Primary Service Address:
Mo. Fee: $49 Usage Included: Unlimited
Activation Fee: s0 Promotions:
Feature Code:
City:
State:
Modem Manuf.: Sierra Wireless
ZIP:
—
Model: Aircard 350 EID: 00 -AO -D5 -02-5A-80
Primary User Phone No.:
PocketNet Custom Homedeck? ❑ Yes ❑ No
PocketNet Cell No.:
Homedeck Name:
Internet Secured Feature? ❑ Yes, one time $25 fee ® No
Office use only:
NEI:
DSN:
AIC:
Primary User.
Rale Plan Name:
Primary Service Address:
Mo. Fee: $ Usage Included:
Activation Fee: $0 Promotions:
Feature Code:
City:
State:
Modem Manuf.:
Zip:
—
Model: EID:
Primary User Phone No.:
PocketNet Custom Homedeck? ❑ Yes ❑ No
PocketNet Cell No.:
Homedeck Name:
Internet Secured Feature? ❑ Yes, one time $25 fee ❑ No
Office use only:
'
NEI:
DSN:
A/C:
Primary User.
Rate Plan Name:
Primary Service Address:
Mo. Fee: $ Usage Included:
Activation Fee: $0 Promotions:
Feature Code:
City::
State:
Modem Manuf:
LP:
—
Model: EID:
Primary User Phone No.:
PocketNet Custom Homedeck? ❑ Yes ❑ No
PocketNet Cell No.:
Homedeck Name:
Internet Secured Feature? ❑ Yes, one time $0 fee ❑ No
Office use only:
NEI:
DSN:
AIC:
Attach additional sheets if necessary.