activation information：激活信息

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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