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• • • • r \ ° "' Ved wireless This form will allow you to transfer billing responsibilities for a Verizon Wireless mobile telephone number currently held by your employ ?r to you. 1. Complete all the applicable fields below. 2. If you are eligible, or required, to chanZe your calling plan to a cons D on the Verizon Wireless website at verizonwireless.cotn. Select an appn before submitting this request..Provide the new calling plan information by cc below. The change will become effective once the transfer of liability is comp 3. Read the terms and conditions of this Transfer of Billing Responsibilit' 4. Read and accept the Terms and Conditions of the Verizon Wireless C -- --- �stomer Agreement from your Organization or Verizon Wireless represenlyry istomer Agreement in the search field). 5. When returning this form via e-mail you must click the box abok actronic acceptance of these terms. Save a copy of the fo uploak ,way at httos:// b2b. verizonwireless .com /tbmb /formuploaderI ddress ust t ,(�/ IId then be e- mailed to WFMWESTSATSUPPORT @VE LE, ccepted from the Organization's email domain. Once the f is rec ved, ter's e • mail box. An email must be received from both the hing < icce- these terms. 6. If e-mail process is not available, return this form via Fax, have bo J fax this form to:949- 286 -8548 Note: Completion timelines for the Assumption of Liabili request is 3- - gS' � Account Information (As�.'. Wireless Number to be Transferr reate New Billing Account: Yes W No ❑ Assuming Customer Name: Add to Existing Account Number if applicable Billing Address: No PO Boxes ° �J r � E y3 Ave, Date of Birth: 2 - 1.3 -7z Social Security #: Billing Address (Cont): E -Mail Address: RYA —` 0RA1M - TMIV, cDM zip C de: city: L�l/�j'E/vL State: OR 97�OS Lic rise Number: ' 2 g G - 13 1 State: DP Primary Address for Use (if different than billing) Note. No P.O. Boxes: ! fAm Lr Csyj H_ a Pho e: 7 City: State:_ Zip Code: Wo one: y/ g - 3 Calling Plan Name: Home Airtime Minutes: I Monthly Access Fee: .. • Upon processing of the transfer of billing responsibilities, a new personal account will be established for you, for this mobile telephone number for which you agree to assume all financial responsibility. • Establishment of your new personal account is dependent upon a credit check. Some of your personal information above will be used In conjunction with that credit check. A deposit may be required to establish this account. • You will be required to accept a one -year contract term unless there is less than 12 months remaining on the existing contract, then the remainder of the existing contract term will carryover to your new account. • You may be subject up to a $175 Early Termination Fee pursuant to the terms and conditions of both the Transfer of Billing Responsibilities the Customer Agreement and • If you are receiving discounted monthly access fees as a benefit of your employment: You understand that this discount is based n your organization's agreement with Verizon Wireless, and that from time to time, your discount rate may be adjusted in accordance wi your organization's agreement. You agree that, if you are otherwise subject to an Early Termination Fee, you will not be p erminate your service without being liable for such Early Termination Fee solely because of a change in your rates resulting frylrp( di unt adjustment to which your organization has agreed_ l • To continue to receive your organization's monthly access fee discount, you m mplete the R er Li e RYL) rocess. You can check for eligibility and register for an employee discount at www.verizonwireless. / et un • You understand that certain information relating to your service, including 7e ur lle el ne n b d total monthly charge may be released to your organization. • Verizon Wireless reserves the right to require proof of your employment (Co any ID adge p s review of your employment status reveals that you are not, or are no longer, an employee of organization, your Wireless a the i t to remove this discount and move ou to a commercial) available calling Ian or to a non - discounted service Ian for the re nder of line term commitment. ❑If you received this form electronically and are returning via e your electro nic acceptance of - these terms and the Customer Agreement An email must be received from both the relinquishing and assuming parties to ensure that each party has cr a e led these terms. Si ned: I Print Name: q„/ Date- O rganization • The account identified must be current (no past due balance) before Verizon Wireless can transfer it to another party. The individual signing this Transfer of Liability on behalf of Organization represents that they have the legal capacity to bind Organization. • Organization remains responsible for all charges incurred until the line is transferred. • By signing this form, -or checking the box below, Organization agrees to release liability for the mobile telephone number indicated above. If returning via email, the Organization representative must include their name and date. Ulf you received this form electronically d are returning via e-mail, please check the box to the left to acknowledge your electronic acceptance of these terms. An A30 must be f bot relinquishing and assumin arties to ensure that each a has acce red these terms. Signed: Title: 2�. „,_, _