Choose Your Initial Term Commitment

PLEASE SELECT YOUR INITIAL TERM COMMITMENT BELOW *

12-MONTH INITIAL TERM ($50 Activation Fee)

Optional Services:

Mailed Bill Fee - $1.00 per month per invoice (Domestic US mailing addresses only)

US Number Access - $3.95 per month per phone

CUSTOMER INFORMATION - BILLING

Mailed Bill Fee - $1.00 per month per invoice (Domestic US mailing addresses only)

Are you an existing Outfitter Satellite customer? *

Yes

No

Please provide your Outfitter Satellite Account Number

Is this a Personal Account or a Business/Corporate Account? *

Personal Account

Business/Corporate Account

First Name *

Last Name *

Title/Position *

COMPANY NAME *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address (REQUIRED FOR EMAIL INVOICE DELIVERY AND OTHER NOTIFICATIONS) *

CREDIT CARD INFORMATION

IMPORTANT: Before your service is activated and/or your order is shipped, you must submit your credit card information into our secure credit card web portal. Once we receive your completed service agreement, our customer service team will send an email to the main email address listed on this form with an enclosed link to our secure credit card portal where you will enter and save your credit card information. Service agreements received outside of normal business hours will be processed the following business day. We cannot activate service if the credit card information or Security Code for the card cannot be verified by our system.

For your protection, Outfitter Satellite systems or personnel do not see your full credit card information. Our billing system only stores tokenized information to enable it to use the card to pay future charges related to the service (or rental) agreements active under your account. For future card identification, we retain the card type, the last four digits of the card, and the expiration date.

By signing below, you warrant that you are the Cardholder or an authorized user of any card that is entered into the secure credit card web portal and agree that all charges described in this agreement (and any other service or rental agreements) made between OUTFITTER SATELLITE, INC. and the above named Customer can be made to the Cardholder’s credit card. You warrant all the information that you are submitting is accurate and that the credit card that you are supplying through the secure credit card web portal is being supplied as a guarantee that all the charges described in this agreement (and any other service or rental agreements on the Customer’s Outfitter Satellite account) will be paid.

Is the name on the credit card the same as the BILL TO: *

YES

NO

NOT APPLICABLE

CARDHOLDER'S INFORMATION

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

AUTHORIZED USERS ON ACCOUNT - PERSONAL

Why do we need you to name an Authorized User? This person needs to be a trusted individual such as a spouse or business associate that can act on your behalf in the event we are unable to reach you. In the event that there is a billing or technical issue that could affect your service, this person can act on your behalf to assist in continuing or restoring your service.

What is an Authorized User with Full Access rights? An Authorized User with Full Access rights is authorized by the Customer to discuss and view all rental and usage bills including detailed call records and make changes to rental or service plans including canceling service or activating new service, and receive technical support as per the terms of this agreement or other agreements executed separately by the Customer.

The Customer names the persons below as Authorized User(s) with Full Access rights:

First Name *

Last Name *

MUST BE DIFFERENT FROM

MAIN CONTACT PERSON ABOVE

Phone Number *

Email Address *

MUST BE DIFFERENT FROM CONTACT

INFORMATION OF MAIN CONTACT

AUTHORIZED USERS ON ACCOUNT - CORPORATE

Why do we need you to name additional Authorized Users? For corporate accounts, naming the Accounts Payable person for your company an Authorized User is necessary to allow them to discuss billing issues and information. It is also useful for us to identify other people within the company that can discuss billing issues, make purchases, or receive technical support related to your account in the event we are unable to reach you.

What is an Authorized User with Full Access rights versus Technical Support rights only? An Authorized User with Full Access rights is authorized by the Customer to discuss and view all rental and usage bills including detailed call records and make changes to rental or service plans including canceling service or activating new service, and receive technical support as per the terms of this agreement or other agreements executed separately by the Customer. A customer with Technical Support rights is only authorized to receive technical guidance on the use of the satellite communications equipment.

The Customer names the persons below as Authorized User(s) with Full Access rights:

ALTERNATE CONTACT PERSON *

TITLE/POSITION *

MUST BE DIFFERENT FROM

MAIN CONTACT PERSON ABOVE

Phone Number *

Email Address *

MUST BE DIFFERENT FROM CONTACT

INFORMATION OF MAIN CONTACT

___________________________________________________________________________________________________________________________________

AP CONTACT PERSON *

Phone Number *

Email Address *

MORE AUTHORIZED USERS (OPTIONAL)

Add an additional user? *

Yes

No

Do you want them to have Full Access rights or Technical Support only rights?

TECH SUPPORT ONLY

FULL ACCESS

CONTACT NAME *

TITLE/POSITION *

Email Address

Phone Number

ATTESTATION FOR PRIMARY PLACE OF USE

Outfitter Satellite, Inc. needs to know the PRIMARY PLACE OF USE of the satellite services being purchased by the Customer for tax purposes. The Customer hereby certifies that the PRIMARY PLACE OF USE will be: (select one) *

Outside the United States and its territories

At the Customer's Billing Address

Inside the United States at the following address other than the Customer's Billing Address

PLEASE LIST OTHER ADDRESS

Street Address *

Address Line 2

City *

State *

Zip Code *

SIGNATURE / VERIFICATION

BY SIGNING BELOW, I AM ACTIVATING A SERVICE AGREEMENT WITH OUTFITTER SATELLITE, INC. AS INDICATED ABOVE, AND I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND ALL THE TERMS AND CONDITIONS INCLUDED IN ALL PAGES OF THIS AGREEMENT INCLUDING THE TERMS AND CONDITIONS INCORPORATED BY REFERENCE FOUND AT www.OutfitterSatellite.com/adobe/TermsConditions.pdf AND I AGREE TO BE BOUND THEREBY, OR IF I AM SIGNING IN A REPRESENTATIVE CAPACITY, I AGREE THAT THE ENTITY FOR WHICH I AM SIGNING WILL BE BOUND THEREBY. IF SIGNING ON BEHALF OF AN ENTITY, I REPRESENT AND WARRANT THAT I AM A DULY AUTHORIZED REPRESENTATIVE OF THAT ENTITY AND I HAVE SUBMITTED THIS APPLICATION IN MY OFFICIAL CAPACITY AND I WARRANT AND REPRESENT THAT I HAVE FULL AUTHORITY TO DO SO AND TO BIND SAID ENTITY. *

clear

PRINTED Name *

DATE * +

SIGNATURE - Please sign in the space above using your mouse/finger/stylus.