REGISTRATION & ORDER FORM

FIRST NAME *

LAST NAME *

BUSINESS NAME

EMAIL ADDRESS *

VERIFICATION CODE *

BILLING STREET ADDRESS *

CITY *

STATE *

ZIP CODE *

PHONE NUMBER *

HOW DID YOU HEAR ABOUT US: *

ACTIVATION INFORMATION

DO YOU WANT TO KEEP YOUR NUMBER? *

SIM CARD OPTION *

SIM CARD NUMBER (if you have your own)

FILL OUT THE INFORMATION BELOW THIS IF YOU ARE KEEPING YOUR NUMBER!

Name of Previous Carrier

Phone Number to be Ported

Zip Code If on File w/ Carrier!

Account Number From Current Carrier

Security Pin # From Current Carrier If No Pin Enter 0000

Be sure that your information is accurate, if you are not 100% confident of your information call your current carrier to get the correct information. It will help ensure that your port goes through smoothly. Ports can take up to 24 hours to complete but can go through as soon as 5-10 minutes as well.

SOLAVEI CUSTOMERS... Your Account Number is your Phone Number and your Pin # is 0000

NOTES/COMMENTS

BILLING INFORMATION

(Your card will not be charged until the activation is approved)

CHARGE WILL BE: $35 including all taxes & fees.

($49 Total Charge if you Ordered a new Sim Card)

Card Type *

CREDIT/DEBIT CARD NUMBER *

MONTH *

YEAR *

CVC (Security Code) *

AUTO PAY

KEEP CARD ON FILE FOR AUTO PAY

*

I'VE READ & ACCEPT THE TERM & CONDITIONS (review T&C's at http://rewardswireless.biz/terms-and-conditions/

If you have any questions please contact us at 800-910-4383