DIS Wireless Service Order Form



University of Central Arkansas

Cell Phone Purchase Justification Form

Name

Department

University of Central Arkansas recognizes the productivity enhancing qualities of cell phone use. The university also recognizes the responsibility it has to the taxpayer to allocate resources based on need of service. We are requesting that you provide a brief description of your requirements for cell phone use and the anticipated productivity enhancements cell phone use will provide.

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(If additional space is needed please attach your comments on a separate sheet of paper.)

Requisitioner Signature Date

Chair/Department Head Signature Date

Dean Date

Vice President Date

Please attach this form to your telephone service request form.

DIS Wireless Service Order Form

|Date: | | |SO Number: (for internal DIS use only) | |

| | | |Authorized By: | |

|Department Name: | | | | |

| | | | | |

|Contact Name: | | |Contact Phone #: | |

| | | | | |

|User Name: | | |DIS (4 digit) Acct #: | |

| | | | | |

|Physical Delivery Address - No P. O. Boxes Allowed |

|Department: | | | |

|Street: | |

|Suite/Room Number: | |

|City: | |State: |AR |Zip: | |Phone #: | |

Service Requested:

| |New Service: |Preferred Service Area – (*) | |

| |Convert Cingular Service to State Plan |List Cingular 10 Digit Phone #: | |

| |Accessories & Optional Services |List Cingular 10 Digit Phone #: | |

| |Disconnect Service |List Cingular 10 Digit Phone #: | |

(*) NOTE: Specify if the cell phone number should be a number local to the user or whether it is to be a Little Rock telephone number. If local to the user, specify both Area Code and Prefix.

|Phone Type Options: |Quantity |

| |Nokia 1200 Series tri mode phone |Free | |

| |Ericsson T62u Digital (WAP enabled) |Free | |

| |Use existing phone (list make, model and ESN) | |

| |Nokia 6340i Digital (WAP enabled) |$ 29.00 | |

| |Nokia 8265 Digital |$ 99.00 | |

| |Nokia 3560 Digital with color display |$ 79.00 | |

| |Motorola V60TI Digital (WAP Enabled) |$ 79.00 | |

DIS Calling Plans:

| |Basic Plan (114 minutes) (Addl$.08) |$ 12.50 |D13AR114 WCAL LD10MINR |

| |Plan 1-National Plan (250 minutes) (Addl $.45) |$ 31.97 |CP3N00001 corpmac10 |

| |Plan 2-National Plan (350 minutes) (Addl $.45) |$ 42.63 |CP4N00001 corpmac10 |

| |Plan 3-National Plan (500 minutes) (Addl $.39) |$ 53.30 |CP5N00001 corpmac10 |

| |Plan 4-National Plan (850 minutes) (Addl $.39) |$ 74.62 |CP6N00001 corpmac10 |

| |Plan 5-National Plan (1200 minutes) (Addl $.39) |$ 106.61 |CP7N00001 corpmac10 |

| |Plan 6-National Plan (2000 minutes) (Addl $.35) |$159.92 |CP8N00001 corpmac10 |

| |Plan 7-National Plan (3000 minutes) (Addl $.29) |$213.23 |CP9N00001 corpmac10 |

Note: All plan prices exclude tax. All current National Plans include 5000 Bonus Night and Weekend Minutes that may be used 9 p.m.-7 a.m. Monday-Thursday and 9 p.m. Friday through 7 a.m. Monday. Additional minute prices are also shown. National Plans will also incur a $.79 per minute roaming charge if outside the coverage area.

Battery Options / Telephone Accessories:

|Nokia |

|Accessory |Note Phone Model |SKU |

| Battery – $30.00 |1261, 3360 or 3560 | |62981 |

| |6340 or 8265 | |62984 |

| |5165 | |60012 |

| 5165 Vibrating Battery - $34.00 | | |60014 |

| Belt Clip - $5.00 |1261, 3360 or 3560 | |61895 |

| |5165 or 6340 | |60077 |

| Holster - $7.00 |1261, 3360 or 3560 | |61783 |

| |6340 | |63104 |

| Swivel Leather Case -$12.00 |1261, 3360 or 3560 | |61199 |

| |6340 | |62065 |

| |8265 | |62705 |

| |5165 | |60038 |

| 5165 External Antenna - $15.00 | | |61242 |

| Hands Free Ear Piece - $15.00 |1261, 3360, 3560 or 8265 | |60379 |

| |5165 or 6340 | |60081 |

| Cigarette Adapter - $28.00 | | |60065 |

| A/C Wall Charger - $15.00 | | |60344 |

| Hands Free Car Kit - $154.00 (2 pieces |1261, 3360 or 3560 | |62973 |

| | | |62975 |

| Hands Free Car Kit - $154.00 |5165 or 6340 | |60089 |

Battery Options / Telephone Accessories:

|Motorola |

|Accessory |SKU |

| Li Ion 850 MAH - $45.00 |62985 |

| Holster - $7.00 |63036 |

| Leather case - $12.00 |62883 |

| Hands Free Ear Piece - $15.00 | 61115 |

| Cigarette Adapter - $28.00 |61946 |

| Wall Charger - $15.00 |61790 |

| Desktop Stand w/clock - $49.00 |62089 |

| Data Connect Kit for V60TI (with USB Cable) – $49.00 |62625 |

| Hands Free Portable Kit – $99.00 |62772 |

| Hands Free Car Kit - $199.00 (2 pieces) |62826 & 62877 |

|Ericsson |

|Accessory |SKU |

| Battery - $30.00 |62033 |

| Holster - $7.00 |62639 |

| Leather Case - $12.00 |61942 |

| Hands Free Ear Piece - $15.00 |61259 |

| Cigarette Adapter – $28.00 |61250 |

| Wall Charger - $15.00 |61912 |

| Desktop Stand - $30.00 |61915 |

| Data Connect Kit for WAP Phones (w/ USB Cable) - $49.00 |62621 |

| Hands Free Car Kit -$175.00 (3 pieces) |61920 |

| |61923 |

| |61924 |

Optional Services:

| |Add | |Delete |Phone-to-Phone: ($10/mo) - This option provides 5000 minutes calling between Cingular wireless telephones if the |

| | | | |originator of the call is within Arkansas. Minutes of use between telephones having this option do not count against|

| | | | |the billable airtime. (This feature may be added to the Nationwide Plans). |

| | | | |SOC DM2M5K |

| | | | | |

| |Add | |Delete |Messaging Bundle: ($10/mo) - Unlimited paging, email, text messaging and Wireless Internet. Airtime still applies. |

| | | | |SOC WORKS |

| | | | | |

| |Add | |Delete |Roadside Assistance ($3/mo) |

| | | | |SOC CRS |

| | | | | |

| |Add | |Delete |Unlimited Long Distance: ($1/mo plus tax) – Calling from Arkansas home area to anywhere in the United States with no|

| | | | |toll charges. (Available only with the Basic Plan) |

| | | | |SOC DIS1 |

| | | | | |

| |Add | |Delete |5000 Minutes Off-Peak: ($10/mo plus tax) - Allows additional 5000 off-peak minutes from 9 p.m. to 7 a.m. Monday |

| | | | |through Thursday and 9 p.m. Friday through 7 a.m. Monday. (Available only with the Basic Plan) |

| | | | |SOC DNW5K |

For Internal Use Only:

|Major Account Number: ARK1DIS |Activate new service on BAN 361277381 |

|Telegence Comp Code: 20970 |Use last name and 5 digit Reference order number in user field |

|Use 5 digit order number as compass PO |Address questions to Ryan X432759 |

|Compass ID: N04100031 |SOC may be specific to Direct Market |

Revised 7/23/2003

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