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BYU–Hawaii Department Cell Phone
New Activation/Upgrade T-Mobile Order
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
