Verizon Wireless - Georgia Technology Authority



Verizon Wireless - Georgia Technology Authority

Contract GTA-000187-010

Wireless Service & Equipment Inquiry

Please complete the information requested below and fax the document to: 678-868-2083. A Verizon Wireless Government Account Manager will contact you within 24 hours to discuss you needs.

Today’s Date:___________________________________

Agency Name:______________________________________________________________

Street Address:______________________________________________________________

City:_______________________________________ State: GA ZIP:_______________

Authorized Contact Person:____________________________________________________

Title:___________________________________ Telephone:_________________________

E-mail address: _____________________________________________________________

We Are Interested in information on the following wireless services (check all that aply):

|θ |Voice Service | |θ |Automatic Vehicle Locator Systems |

|θ |Push-to-Talk | |θ |Interoperable Communications |

|θ |Wireless e-mail | |θ |PDA/Smartphone |

|θ |Public Safety Applications | |θ |Internet Billing & Reporting |

Other Interest:_______________________________________________________________

Is your agency already a Verizon Wireless Customer? (Y/N) _____

Account Number:________________________________________

Is this inquiry in conjunction with a formal Request for Proposal (RFP)? ________________

If you answer “Yes,” Please fax the RFP document with this form.

Who is your existing carrier: _______________________ How Many Lines: ____________

Federal Tax ID:_________________________ D&B:_______________________________

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