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B illin g Transfer of Respo nsibilities C orporate . Personal/Emp Assumption of . r r V('f1�Ilwireless This form will ,allow you to transfer billing responsibilities for a Verizon Wireless mobile telephone number currently held by your employer to you. 1. Complete all the applicable fields below. 2- If you are eligible, or required, to change your calling plan to a consumer plan, please review the available calling plans on the Verizon Wireless website at verizonwireless.com. Select an appropriate calling plan and make necessary changes before submitting this request - Provide the new calling plan information by completing the fields in the Calling Plan Change section below. The change will become effective once the transfer of liability is complete. 3. Read the terms and conditions of this Transfer of Billing Responsibilities Form. 4. Read and accept the Terms and Conditions of the Verizon Wireless Customer Agreement. You may obtain a copy of the Customer Agreement from your Organization or Verizon Wireless representative or online at verizonwireless.com (enter in Customer Agreement in the search field). 5. When returning this form via e-mail you must click the box above the signature line below to acknowledge your electronic acceptance of these terms. Save a copy of the forth and upload it to the Verizon Wireless Secure Document Gateway at httas: //b2b. verizonwireless .com /tbmb /fbrmuploader/ (address must be manually typed in to your browser). The form should then be e- mailed to WPMWESTSATSUPPORT @VERIZONWIRE SS.COM. Relinquishing party a -mails will only be accepted from the Organization's email domain. Once the form is a confirmation e-mail notice will be sent to the requester's e- mail box. An email must be received from both i and assuming parties to ensure that each party has accepted these terms. 6. If e-mail process is not available, return th have both parties sign and print at the bottom of this form and fax this form to:949- 286 -8548 Note: Completion timelines for the Assum lion of Liability re guest is 3-5 business da s. Account Information Customer) '753 —5 9 (Assuming Wireless Number to be Transferred: l50 9 Create New Billing Account: Yes 19 No ❑ Assuming Customer Name: R AAI 'T// 1JeR Add to Existing Account Number if applicable): Bi . Iling Address: No PO Boxes `t56 E y3!V AYE Date of Birth: 2 - 13 - 72 1 Social Security #: Billing Address (Cont): E -Mail Address: R R _1 - &RR,, AFROrp3 6V ' rAhtv , cvAl UGE ®R Zip C de: p Z G 73 1 cit State: 9705 Driver's License Number.1 I g State: OR Primary Address for Use (if different than billing) 3 'If - 9Y6 e Note: No P.O. Boxes: StgMLr Home Phone: l? City: State:. Zip Code: Work Phone: `!/ 6BZ - qS #3 Require Calling Plan Change - If (Assuming Customer) Calling Plan Name: Home Airtime Minutes: I Monthly Access Fee: PersonallEmployee Assumption Liability Customer) of (Assuming • Upon processing of the transfer of billing responsibilities, a new persona ll 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 depend t e of your personal information above will be used in conjunction with that credit check. A deposit may be r is account • You will be required to accept a one -year contract term 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 and the Customer Agreement. • If you are receiving discounted monthly access fees as a benefit of your employment: You understand that this discount is based on your organization's agreement with Verizon Wireless, and that from time to time, your discount rate may be adjusted in accordance with your organization's agreement. You agree that, if you are otherwise subject to an Early Termination Fee, you will not be permitted to terminate your service without being liable for such Early Termination Fee solely because of a change in your rates resulting from a discount adjustment to which . your organization has agreed. • To continue to receive your organization's monthly access fee discount, you must complete the Register Your Line RYL) Process. You can check for eligibility and register for an employee discount at www. verizonwireless .com /getdiscounts • You understand that certain information relating to your service, including your name, your mobile telephone number and total monthly charge may be released to your organization. • Verizon Wireless reserves the right to require proof of your employment (Company ID badge or pay stub). if a review of your employment status reveals that you are not, or are no longer, an employee of your "organization, Verizon Wireless reserves the right to remove this discount and move ou to a commercially available calling Ian or to a non - discounted service plan for the remainder of your line term commitment. ❑If you received this form electronically and are returning via e-mail, please check the box to the left to acknowledge your electronic 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 these terms. W , Print N IRAILM 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. ❑If you received this form electronically and are returning via e-mail, please check the box to the left to acknowledge your electronic acceptance of these terms. An email must be received from both the relinquishing and aisuming parties to ensure that each party has accepted these terms. Signed: Title: