BYU–Hawaii Department Cell Phone

Department Name

Employee Name

Contact Number

T-Mobile Phone Number

If Applicable

Phone Order Type

New Activation

Upgrade

Phone Model

GB

Color

Price of Phone

Plus Tax 4.712%

Subtotal

Upgrade Discount

If upgrade and qualified, enter -$150.00 below

Final Price

Employee Pays

Enter the amount the employee is responsible to pay

Dept Pays

Enter the amount the department pays

Reason for upgrade

Plan Choices

Basic Plan: $19.00/month

Data Cell Phone Plan: $31.50/month

Other Options

*Office Note: Need to complete Port Over form

Transfer number from different carrier

Transfer number from personal T-Mobile

Phone # being transferred

Department Account Number to Charge

(Account format: xx-xxxxxx-xxxx)

Department Chair/Director's Name

Captcha Field