HTC EVO™ 4G LTE. Free with Voucher ... Devices shown require a new-line
activation (or eligible upgrade) on a plan with data, Premium Data add-on and ...
SPRINT RELAY STORE WIRELESS ORDER FORM FOR NEBRASKA RELAY PRICE EXPIRES 05/09/2013 First Name
Middle Initial
Last Name
Customer Name:
New Phone? Check Here
OR
Upgrade? Check Here
Phone Number: _ _ _- _ _ _ -_ _ _ _
SELECT THE DEVICE YOU WISH TO ORDER Samsung Galaxy S® III, 16GB Free with Voucher Select: MARBLE WHITE or PEBBLE BLUE
Samsung Galaxy Note® II Free with Voucher Select: MARBLE WHITE or TITANIUM GRAY
HTC EVO™ 4G LTE Free with Voucher
Select: BLACK or WHITE
Samsung Galaxy S® II Free with Voucher
TITANIUM
BlackBerry® Bold™ 9930 Smartphone Free with Voucher
Devices shown require a new-line activation (or eligible upgrade) on a plan with data, Premium Data add-on and two-year Agreement.
Other Device: ___________________________ Page 1 of 4
SPRINT RELAY STORE WIRELESS ORDER FORM FOR NEBRASKA RELAY
Salesperson: Arthur Moore
For Internal Use Only: Subcontractor: ____________________________
TOTAL EQUIPMENT PROTECTION: Your initials here: ___ Decline, no charge Your initials here: ___ Accept, $8 or $11/month (pricing varies by device) Total Equipment Protection is highly recommended. Without it, you may have to purchase a new phone at manufacturer’s suggested retail price (MSRP) if your phone is damaged, lost, or stolen. A nonrefundable deductible applies for approved claims for loss, theft, physical or liquid damage claims.
First Name
Middle Initial
Last Name
Customer Name: Billing/Shipping Address: City
State
Zip Code
Email Address: Videophone/ Home Contact #: Date of Birth: Social Security #: Driver’s License #: Credit Card Type:
__ __ __ -- __ __ __ -- __ __ __ __
Required
MM / DD / YYYY
Required for credit check
__ __ __ -- __ __ -- __ __ __ __
Required for credit check
_________________________ State Issued: _____ ___ Visa
___ MasterCard
Exp Date:
MM/DD/YYY
___ American Express ___ Discover
Name on the Credit Card: Credit Card #:
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ MM / DD / YYYY
Card Verification Code:
Card Expiration Date:
DEPOSIT: I understand Sprint will perform a credit check. You may be required to pay a deposit based on the credit check. If all monthly payments to Sprint are received on time, the deposit will be returned to you in 12 months. By checking below, you authorize us to charge your credit card, if a deposit is needed. If you select None, and your credit check does not pass approval, you will not receive a device without paying a deposit. I approve a deposit if needed: ____ None
____ $50
_____ $100
_____ $150 ____$250
Your initials here: _____ This indicates that I understand Sprint will perform a credit check.
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SPRINT RELAY STORE WIRELESS ORDER FORM FOR NEBRASKA RELAY Please create a numeric PIN or provide your existing Sprint account PIN.
Create your own 6 to 10 Digit PIN#:
___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Please select your security question and fill in your answer. Who is your business mentor?
Favorite author?
Street you grew up on?
First name of childhood best friend?
First pet name?
First elementary school name?
ANSWER: DATA ONLY PLAN (Requires a two-year Agreement) While on the Sprint network: Unlimited email Unlimited internet access Unlimited Instant Messaging (IM) Unlimited domestic SMS text and Picture Messaging o Video text messages are not included Incoming calls are blocked on all devices. The block is not removable on Google Android OS, iOS, and Windows OS devices. o However, on all other devices the block can be removed by contacting our video customer service (
[email protected]) o If the incoming block is removed, you will be billed $0.20 / minute for local voice calls or $0.40 / minute for long distance voice calls Monthly Plan—Sprint Relay Discount Plan: Sprint Relay Data Only Plan - $39.99 / month ($29.99 plus $10 required Premium Data add-on) with two-year Agreement plus taxes and any add-on options. The devices below require the $29.99 Sprint Relay Data Only Plan Model Model Kyocera Milano™ BlackBerry® Curve™ 9350 HTC Touch Pro2 BlackBerry® Bold™ 9930 ® Samsung Galaxy S II Sprint Relay Data Only Plan - $54.99 / month ($44.99 plus $10 required Premium Data add-on) with two-year Agreement plus taxes and any add-on options. The devices below require the $44.99 Model Samsung Galaxy S® III Samsung Galaxy Note® II MOTOROLA PHOTON™ Q 4G LTE HTC EVO™ 4G LTE ZTE Fury™ Kyocera Rise LG Optimus Elite™ LG Viper™ 4G LTE Samsung Transform™ Ultra Galaxy Nexus Sprint 4G LTE Network available in limited markets
Sprint Relay Data Only Plan Model LG Mach™ MOTOROLA ADMIRAL™ Samsung Galaxy Victory™ 4G LTE Sprint Flash™ LG Optimus G™ Sprint Force™ Kyocera Torque LG Rumor Reflex™ Samsung Array™
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SPRINT RELAY STORE WIRELESS ORDER FORM FOR NEBRASKA RELAY * Not applicable for Data Cards and Tablets * **Monthly charges exclude taxes, Sprint Surcharges incl. USF charge of up to 16.1% (varies quarterly), Administrative Charge (up to $1.99/line/mo.), Regulatory Charge ($0.40/line/mo.) & state/local fees by area. Sprint Surcharges are not taxes or gov’t-required charges and are subject to change. Details: Sprint.com/taxesandfees. Although Sprint IP, Fed IP, Sprint IP using IM, and WebCaptel can be used for emergency calling, such emergency calling may not function the same as traditional 911/E911 services. By using Sprint IP, Fed IP, Sprint IP using IM, and WebCaptel for emergency calling you agree that Sprint is not responsible for any damages resulting from errors, defects, malfunctions, interruptions or failures in accessing or attempting to access emergency services through Sprint IP, Fed IP, Sprint IP using IM, and WebCaptel whether caused by the negligence of Sprint or otherwise. Featured devices may also be activated on voice plans. See Sprint Relay Representative for details and plan options. May require up to a $36 activation fee/line, credit approval & deposit. Up to $350/line early termination fee (ETF) for advanced devices & up to $200 ETF/line for other devices (no ETF for Agreements cancelled in compliance with Sprint’s Return Policy). Sprint Relay Data Only Plan: Offer ends 05/09/13. Messaging: Includes text and picture for domestic messages sent or received. Video text messaging is not included. International messages sent or received from the U.S. are $0.20/msg; international messages from outside the U.S. are up to $0.50/msg. SMS voice messages may incur an additional data charge of $0.03/KB. Data: Premium content/downloads (games, ringers, songs, certain channels, etc. are add’l charge. Text to 3rd parties to participate in promotions or other may result in add’l charges. Sprint Music Premier/Sprint Radio includes access to select radio channels and song downloads (cost varies). Sprint TV Premier includes select channels. See Sprint.com/tvguide for channel information. Content and channel line-up subject to change. Voice/Data Usage Limitation: Sprint reserves the right, without notice, to deny, terminate, modify, disconnect or suspend service if offnetwork usage in a month exceeds: (1) voice: 800 min. or a majority of minutes; or (2) data: 300 megabytes or a majority of kilobytes. Prohibited network use rules apply. See in-store materials or sprint.com/termsandconditions for specific prohibited uses. Other Terms: Coverage not available everywhere. Unless otherwise noted, Sprint 4G LTE devices will not operate on the Sprint 4G (WiMax) network; Sprint 4G (WiMax) devices will not operate on the Sprint 4G LTE network. Sprint 4G (WiMAX) network reaches over 70 markets, on select devices. See sprint.com/4G for details. The Sprint 3G Network reaches over 278 million people. Offers & service plan features not available in all markets/retail locations or for all phones/networks. Pricing, offer terms, fees & features may vary for existing customers. Other restrictions apply. See www.sprintrelaystore.com for details. ©2013 Sprint. Sprint and the logo are trademarks of Sprint. Research In Motion, the RIM logo, BlackBerry, the BlackBerry logo and SureType are registered with the U.S. Patent and Trademark Office and may be pending or registered in other countries - these and other marks of Research In Motion Limited are used with permission. The HTC logo and HTC EVO are the trademarks of HTC Corporation. LTE is a trademark of ETSI. Other marks are the property of their respective owners.
Upgrading to this device may require the $10/month Premium Data add-on upon activation: Your initials here: ___ One-time $12 shipping & $36 activation fee will be included on your first bill from Sprint: Your initials here: ___ MAILING LIST: Sprint Relay may email you regarding products and services that we think may be of interest to you. You can opt out at any time. ____ Yes, add me to the mailing list ____ No, do not add me to the mailing list By signing this Sprint Application, I understand that I agree to the terms above and to Sprint’s terms and conditions for service (“Terms and Conditions”), which are located at: http://shop2.sprint.com/en/legal/legal_terms_privacy_popup.shtml. Upon my request, Sprint will provide me with a copy of the Terms and Conditions.
SIGNATURE: ____________________________________________ TODAY’S DATE: __________________________________________ Sprint 14-Day Satisfaction Guarantee minus all charges based on actual usage within 14 days Note: Available only through an authorized Sprint Relay Representative
Mail the completed order form with signed original voucher to: Sprint Relay Store Attention: Arthur Moore 34 Jerome Ave, Suite 220 Bloomfield, CT 06002 Questions? Send an email to
[email protected]
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