T-Mobile@Work Direct Sales Corporate Order Form
ACCOUNT INFORMATION ☐ EIP ☐ 3rd Party Lease Finance Option
Company Name/Name:
Authorized Corp Purchaser or Authorized
User(s):
Federal Tax ID:
Billing Attention:
Billing Address:
Type: i.e. (Activation, Upgrade)
**Corp Node: (IL provide 2 forms of emp/member ID’s )
BAN/Onyx:
Credit Approval Code & Class:
Preferred PCS Area Code:
Customer Type:
Existing Mobile Number (Required for Equipment
only, SIM, Accessory or Upgrade Orders):
Tax Exempt: (Required for each new BAN):
Shipping Method:
Billing City/State:
Zip Code + 4:
Business/Home Phone No:
Customer’s Business Email Address:
9-1-1 Address:
Employer/***Personnel # (CRIL Only):
Comments:
9-1-1 City/State/Zip:
Sales Agent Name & Dealer Code:
Joel Saltzman/Dr Wireless/4213912
RMA: ☐
DART ID:
Foreign Applicant: ☐
SERVICES, FEATURES & EQUIPMENT
Product Name
Type
☐ Yes
Shipping Fee Waived: ☐ Yes
Fixed
Term
(months)
EQUIPMENT INSTALLMENT PLAN (EIP)
3rd
SOC
Price
Qty.
Notes/ Device &
Feature Options
EIP?
Party
Lease
Finance
Option
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ Yes
MRC
Tier
Down
Pmt $
Additional
Down Pmt
$
Monthly
Installment
(24 Mo.)
$
ACCESSORIES
Accessory
Accessory Discounts
Qty.
Price $
Total
SHIPPING ADDRESS(ES) and BAN(s)
Business Sales 051115
Total
Business Sales Corporate Order Form
……
Product Name
Type
Quantity
Color
Shipping Attn:
Billing Account
Number (BAN)
Shipping Address
Discounts do not apply to certain Rate Plans in T-Mobile’s sole discretion, and are subject to change at any time without notice. Visit your T-Mobile Premier Extranet via your company intranet or
www.t-mobile.com to review current Rate Plans.
Corporate Benefits/Special Promos/Comments:
Base Price Total for Equipment $
Deposit $
EIP Down Payment Total $
EIP Additional Down Payment Total $
EIP Monthly Payment Total $
Total for Monthly Plan & Features $
Total Price for Accessories $
Zip Code «TEXTBOX:ZIP» Tax $
Total Equipment Amount $
WLNP PHONE NUMBER TRANSFER REQUEST OSP (Other Service Provider) INFORMATION (If applicable)
Tax-ID or Social Security Number:
Company Name (if applicable)
Account Owner /Contact Name:
OSP Passcode:
Desired Port Date:
Secondary Phone Number:
OSP Account Owner Name (if different from
Billing Address (if different from
above):
above)
OSP Billing Account Number:
Billing City, State
OSP Phone Number(s) to Port
☐ See WLNP Bulk Port Form (up to 5 lines)
DELIVERY TYPE
☐ Standard Shipping F.O.B. via standard transportation within five (5) business days of receipt of such order.
☐ Overnight (additional shipping charges may apply)
CORPORATE LIABLE CUSTOMERS ONLY
☐ WLNP Phone Number Responsibility Transfer: By checking this box, signing below and submitting this order, Customer acknowledges that the Other Service Provider (OSP) Account Owner is transferring
full responsibility of the OSP phone number(s) to Customer and Customer accepts full responsibility for the transferred line(s) of service. * Only required if porting OSP Phone Number(s) not under Business
Customer’s Name to Business Customer’s T-Mobile Account.
EARLY TERMINATION FEE ACKNOWLEDGEMENT
☐ Early Termination Fee Amendment to the Master Corporate Services Agreement: By checking this box, signing below and submitting this order, Customer agrees that the terms in the Master Corporate
Services Agreement, or Business Sales Amendment (whichever agreement you signed), as amended by the ETF Tier Amendment, will control over the T-Mobile Terms and Conditions attached to this Business
Sales Corporate Order Form.
INDIVIDUAL LIABLE CUSTOMERS ONLY
☐ Individual Liable Corporate Node Migration Acknowledgement: By checking this box, signing below and submitting this order, I acknowledge that I am an employee or member of the
Company/Organization named above, and that I am a T-Mobile account holder or an Authorized user on the account. To verify eligibility to receive (if available) the corporate discount on eligible Rate
-2-
Business Sales 051115
Business Sales Corporate Order Form
……
Plans and/or features, I acknowledge that I have provided at least two of the following forms of employee/member identification: Company/Organization Main Number; Company/Organization E-Mail
address (must contain Company/Organization name); Promo Code; or Employee or Membership ID. I understand I may be required to verify my employment with the Company/Organization at any
time and if I fail to do so, I will lose the discount(s) (if available). I will notify T-Mobile within 30 days of termination of my employment and/or membership. I may be charged back for any Company/Organization
discounts I receive after my employment/membership terminates.
Provide at least two of the following forms of ID here:
Employee/Membership ID:
Company/Organization Main Number:
Promo Code:
Company/Organization E-Mail address (must contain Company/Organization name):
FOR ALL CUSTOMERS SIGNING THIS FORM, INCLUDING CORPORATE LIABLE CUSTOMERS WHO DO NOT HAVE A MASTER CORPORATE SERVICES AGREEMENT OR BUSINESS SALES
AMENDMENT:
CUSTOMER ACCEPTANCE: By signing this form, activating or using T-Mobile service, I agree that:













I will be charged a monthly Regulatory Programs Fee (not a government-required tax or charge) of up to $2.71 (subject to change without notice; plus tax) per line. This fee may not apply to
certain data devices/services. International rates and roaming charges may apply. Certain rates are subject to change at any time.
If I haven’t signed up for a specific data plan, I will be charged for all data used on a per MB basis (rounded up to the nearest MB) unless I opt out of data service. Data plans may also have
throughput and other limits; including Rate Plan Allotments. Domestic Off-Network data Allotments are: (1) 5MB if my data plan has 1MB to 199MB of full speed data; (2) 10MB if my data plan
has 200MB to 1.99GB of full speed data; (3) 50 MB if my data plan has 2GB to 4.99GB of full speed data, or if my data plan has Unlimited Nationwide 4G data; (4) 100MB if my data plan has
5GB to 9.99GB of full speed data; or (5) 200MB if my data plan has 10GB of data and above.
I may be eligible to receive a discount(s) on eligible rate plans and features. The discount(s) will be applied as a credit to the Monthly Recurring Charges on my bill prior to calculating taxes and
fees. Discounts do not apply to certain rate plans, and are subject to change at any time without notice. Subscribers on a SunCom Rate Plan must select an active post-pay voice or data plan
to receive corporate benefits (if available). Visit your T-Mobile Advantage Extranet via your company intranet or www.t-mobile.com to review current Rate Plans and view the current discount(s).
I understand that my first service cycle may start several days after activation of my T-Mobile service. If I have purchased a device under EIP, I will refer to my EIP agreement for the specific
terms and conditions of that program. If I have enrolled in paperless billing, I will receive billing notifications according to my communications preferences and will not receive a paper bill in the
mail. I may access billing details electronically at www.my.t-mobile.com .
For Individual Liable customers, my “Agreement” with T-Mobile includes: (a) this Business Sales Corporate Order Form; (b) T-Mobile’s “Terms and Conditions”; and (c) any terms specific
to my Rate Plan or service. I can obtain copies of T−Mobile's Terms and Conditions and my Rate Plan specific terms at www.T−Mobile.com/terms-conditions (www.T−Mobilepr.com
for Puerto Rico customers), or by calling Customer Care at (800) 937-8997 or 611 from my T−Mobile phone. I have received and read my Agreement. The English version of this
Agreement will control over any other version.
For Corporate Liable Customers, if I have not signed a Master Corporate Services Agreement (“MCSA”) or Business Sales Amendment (“BSA”), my “Agreement” with T-Mobile
includes: (a) this Business Sales Corporate Order Form; (b) T-Mobile’s “Terms and Conditions”; and (c) any terms specific to my Rate Plan or service. I can obtain copies of T-Mobile’s Terms
and Conditions at T-Mobile at www.T-Mobile.com/terms-conditions (www.T-Mobile.com.pr for Puerto Rico customers), or by calling Business Customer Care at (800) 375-1126 or
emailing T-Mobile at Businesscare@t-mobilesupport.com. I have received and read my Agreement. The English version of this Agreement will control over any other version
For Corporate Liable Customers, if I have signed a Master Corporate Services Agreement (“MCSA”) or Business Sales Amendment (“BSA”), my “Agreement” with T-Mobile includes:
(a) this Business Sales Corporate Order Form; (b) the MCSA or BSA (whichever is applicable); and (c) any terms specific to my Rate Plan or service. I can obtain copies of my Agreement,
by calling Business Customer Care at (800) 375-1126, or emailing T-Mobile at Businesscare@t-mobilesupport.com. I have received and read my Agreement. The English version of this
Agreement will control over any other version. If I signed an MCSA or BSA, the terms of the MCSA or BSA will control over this Agreement.
Disputes. T-Mobile Requires ARBITRATION OF DISPUTES UNLESS I OPT-OUT WITHIN 30 DAYS OF ACTIVATION. See T-Mobile’s Terms and Conditions for details and for procedures
available to Puerto Rico customers for appealing decisions to the Telecommunications Board of Puerto Rico.
Cancellation and Return Policy. I may cancel my Rate Plan, and for service contracts of 1 year or more not pay a termination fee, by going back to the original point of purchase and returning
all Devices I acquired with my activation within 30 days from activating a new Line of Service (Return Period). The Return Period may be longer in some states or if you signed an MCSA.
I may have to pay a restocking fee for any Device I return. If my Rate Plan (including any required data service) is cancelled after the Return Period, I will be required to pay an EARLY
TERMINATION FEE OF UP TO $200, OR UP TO $350, PER LINE OF SERVICE, whichever is applicable, on service contracts of 1-year of more. If my Rate Plan is month to month,
there is no Early Termination Fee for service cancellations.
Deposit. Unless otherwise required by law, I may request a refund of a deposit after 12 months (with simple interest at the rate required by law) if my account has remained in good standing.
I agree that T−Mobile can apply deposits to any amounts I owe on any account, and T−Mobile may require me to replenish my deposit amount.
I understand I may be unable to switch to a different Rate Plan or other service and that if I switch, I may be bound by my existing or an extended contract term (including early
termination provisions and fees) and/or charged a migration fee of up to the early termination fee amount.
I authorize T-Mobile and its agents to obtain information about my credit history and to share that information with credit reporting agencies.
If I am signing on behalf of a corporate, organizational or governmental entity, I represent and warrant that I am authorized to sign on behalf of such entity.
-3-
Business Sales 051115
Business Sales Corporate Order Form
……
SERVICE PAYMENT
**If submitting Credit Card information, for security purposes, the customer should complete the T-Mobile Credit card authorization form that will be sent
separately.
Method of Payment:
PO Information: PO #
SAP #
AP Contact
AP Phone #
EQUIPMENT PAYMENT **If submitting Credit Card information, for security purposes, the customer should complete the T-Mobile Credit card authorization form that will be sent
separately.
Method of Payment:
PO Information: PO #
SAP #
AP Contact
AP Phone #
EQUIPMENT INSTALLMENT PROGRAM (EIP) PURCHASE INFORMATION **If submitting Credit Card information, for security purposes, the customer should complete the TMobile Credit card authorization form that will be sent separately. If I choose EIP to purchase T-Mobile Device(s), I agree to comply with T-Mobile requirements under the EIP
agreement, including, but not limited to, having an authorized signer execute the EIP contract terms and conditions.
Method of Payment:
PO Information: PO #
SAP #
AP Contact
AP Phone #
*Deferred Payment only available for CL customers, device price and tax will be added to the first bill. \oi1\
THIRD PARTY LEASE FINANCE OPTION INFORMATION
If I choose to receive a quote from a third party finance company to lease a non-stock device(s), I understand T-Mobile will forward a third party finance quote(s) for the device(s) I have
selected. I understand that such quote will be subject to credit approval by the third party finance company and I will be required to provide additional information directly to the third party
finance company. Initials: \oi1\
Authorized Purchaser Name:
\n1\
Authorized Signature:
\s1\
Title (Corporate Liable):
Date:
\t1\
\d1\
-4-
Business Sales 051115