HomeMy WebLinkAbout2002-144 Agrmt - US Cellular
U.S. Cellular
US Cellular
Service agreement
addendum to the business service agreement amendment
r_ SERVICE AGREEMI REg. tg ll g: ' GOpy
~ New L~ Extension ~ COR
BILLING INFORMATION ~_'] Individual ~' Business [] Government
Billing Name(Please Print) i ;octal Secmity Number ~irth Date Password
CITY OF ASHLAND
D
Billing Address ;hate IDfivers License Number Expiration Date
20 E MAIN ST v
I
2ity State Zip I Employer Position
A. SHLAND OR 97520-1850
u
?hysical Address (If PO is listed above) A Business Address City State Zip
L
City State Zip uB laxiD956002117 14900pAN Or°up 1D Fo# IExp pt'
Home Phone S Billing Contact Name Contact Phone I~xt.
(541 )482-2770 ~ <ARI OLSON (541)488-5354
Business Phone Ext. E rax Exempt [] Yes If yes, attach certificate Certificate #:
¢41)552-2217 S
1NFERNAL USE ONLY: $ [] Business Guarantor paragraph on the Business Reference Sheet has been completed or if
[] DL [] SS# [] Address ~ DOB Salesperson Initials: sole proprietorship, individual credit information has been provided.
Dealer Use Only~omp/Sales ID #: ILocation ID#-I ~oes me customer nave cm,e.t semce warn [] Yes [] No Jif, yes, existing cellular # [Requested C'rNs peposit Amount
C349 Add service linc to existing account?. [] Yes [] NO I pppmvcd #: FO.O0
1'1123531nv0ice I ........... U.S. Cellular.
2AS# ix umber Cycle7 Close DatqBilling]634980690Account Ntmila;, IFeb[Activati°n°8' 1999Date [541)82%88II[Cellular Telephone Number Unlock Code
SERVICE INFORMATION AND CHARGES
MONTHLY CHARGES AND SERVICES
Price Plan RVCON2109 CORPORATE USAGE 101+ LINES $5.00 ..
Promotion Price Plan
~t Minutes included in plan
Additional Services (SOC)
LOYPWR02 $0.00, PAGEBRCTN $0.00 ;. ~ ~ ~-----.--
total charges for additional services $0.00 * (See page 2 for Details)
Federal and/or State Universal Service Charge (Subject to change without notice)
Faxes
Fotal Monthly Charges and Services
ANNUAL AGREEM ENT:I~XTIgNDED TERM PLAN
(a) Term. The charges for cellular service are specified above. In exchange for United States Cellular Corporation, d,b.a, U .5.
Cellular, (the Company) agreeing to lira it any incrcasc in these rates as explained below ,You agree to..l~.~ain tain cellular servicc under
this A grcem ent for an IN IT IA L T I,.' R M (" IN IT lA L T E R M ") of ll m on thl (eu stora er" a in Itlals ,~1~). Aftcr the expiration o f
the initial terra , this A greetn eat w ill continue for successive 30-day p"~rlods (i.e., tn oath to tn oath) ("~t"e~.c'w'~al Period'), until you notify
the C om puny of your intentions to term inure the A greem eat in accordance w ith the provisions below . During Renew al Perlod,
Yourservice will continue to be billed undcrYourcurrent rate, however any protnotional offerings for the initial term will discontinue.
(b) Rates. The Company will notify You in writing at least 30 days prior to instituting any increase in charges for cellular service.
During this 30-day period, and before the new rates become effective, You may terminate this Agreement by notifying the Company,
in writing, of Your intention to do so. Termination during this 30 day period is not subject to the provisions of Section (c) of this
Agreement. If You do not terminate this Agreement during such 30 day period in this manner, this Agreement will remain in effect·
(c) Term ination.-'7-~' GU may terminate this Agreement at the end of the INITIAL TERM and within the renewal period (as set forth
above) by notifying the Company at any time. You acknowledge that any early termination of this Agreement during the INITIAL
TERM , including, but not limited to, a termination by the Company as provided in Paragrap~l.~,~of,,t, he Terms and Conditions of
Agr¢¢ment~wi~dam~getheC~mpanyinanam~unttha~isdifficu~tt~determine~butthat$-L`~-~)-- represents a reasonable estim ate o f
the Company's dam ages. You agree to pay the Company such amount in addition to, and not in lieu of, all other charges for services
due and ow lng hereunder.
You acknowledge receiving a copy of and agree to: 1) Page 2 containing User Information, Equipra eat Information, Initial
Charges, and Signal D~]n~lff~).j.r est Plus Insurance Information; and 2) The Corn pany's Terms and Conditions of Agreement
(Customer's Initials
By signature below, Subscriber confirms the truth and completeness of the above information. "Agreement" refers to all terms on this
page and the Terms and Conditions of Agreement, as well as any Addenda signed by Subscriber and the Company which incorporate
or reference this agreement. SUBSCRIBER ACKNOWLEDGES READING, AND AGREES TO, ALL TERMS AND
CONDITIONS OF AGREEMENT, WHICH TERMS AND CONDITIONS ARE PART OF AND HEREBY INCORPORATED
INTO THIS AGREEMENT BY THIS REFERENCE, AS WELL AS ALL TERM S AND CONDITIONS ON ANY ADDENDA
SIGNED WITH THIS AGREEMENT. Subscriber further authorizes any personal references or consumer reporting/credit agencies to
furnish Company Subscriber's credit records or history. In the event of unauthorized signature by an agent of a corporate or other
business subscriber, the undersigned agrees to be individually liable for amounts not paid when due.
PAYMENT INFORMATION SIGNATURE
..........Cash Check Authorized Customer Signature Date
:-~i~a .... [~ Mast;rCard E~ American Express ~] Discover /' Sal~ ~epr,se .u tall"ye ~ A.~en t S~t~/ , F/~ la~hq
Credit Card # ExplrationDate: ~'"'ff~ ff~f~ )O A ~/ d t /i~ ~'~
serviceBy initialing here. customer authorizes company to charge future amounts due under this [ ~n~f~"~'l;;
agreement to the credit card account listed above ting--U.S.Cellular.~' 'T
Page 2 of 2
US. Cellular- SERVICE AGREEMENT Contract# M050690881121363
SERVICE INFORMATION AND CHARGES
Activation Fee
Advance Monthly Charge
First Month's Prorated Minutes
Security Deposit
Equipment/Phone Charge (below)
Equipment/Accessories (below)
Installation Charge
Other (specify)
Other (specify)
Other (specify)
Other (specify)
INITIAL CHARGES
Signal Dial Direct* Plus Insurance
Accept: Decline: A7-19- -1
Monthly Loss a.age Mech/Elec
Premium/Phone Deductible
Mobile $3.95 $0 $25
FPortable/Transportable $3.95 $35 $25
Accessories $1.95 $35 $25
If You subscribe to Signal Dial Direct Plus Insurance, You acknowledge that the equipment
listed hero is in Your possession and in good working order. You have received, read and
understood the terms and conditions under which the insurance is offered as outlined in the
brochure. You acknowledge that insurance protection is offered by the insurance company,
and not by U.S. Cellular. Requests for information for claims regarding the insurance will
be directed to Signal. A summary of coverage is available by calling 1-800-480-0167.
USER INFORMATION
FIRE AND RESCUE SHLAND OR 7520-2143
1User Address Home Phone Business Phone Lead Source Code
853 SISKIYOU BLVD (541)482-2770 DNR
EQUIPMENT INFORMATION
ESN/SN tem ID Chescn non: ck One) E] Sale Private E Demo []Loaner: E]Upgrade nce'
IAccessoryDescription QTY LOC SITE ITEM ID PRICE Accessory Description QTY LOC SITE ITEM ID PRICE
Detailed Description of Additional Services (SOCs)
SOC SERVICE PRICE EXPIRATION (if any) SOC SERVICE PRICE EXPIRATION (if any)
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