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 it will provide. (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. This form can be filled out online and pirnted or printed and filled out by hand. This label will not print with the form. Clear This Page Button will not print with this page. DIS Wireless Service Order Form Date: SO Number: (for internal DIS use only) Department Name: Authorized By: 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 Service Requested: New Preferred Service Service: Area – (*) Zip: Local City Phone #: Area Code: Prefix Upgrade phone equipment List Cingular 10 Digit Phone #: 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 #: Little Rock (*) 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: Nokia 1200 Series tri mode phone Ericsson T62u Digital (WAP enabled) Use existing phone (list make, model and ESN) Nokia 6340i Digital (WAP enabled) Nokia 8265 Digital Nokia 3560 Digital with color display Motorola V60TI Digital (WAP Enabled) DIS Calling Plans: Basic Plan (114 minutes) (Addl$.08) Plan 1-National Plan (250 minutes) (Addl $.45) Plan 2-National Plan (350 minutes) (Addl $.45) Plan 3-National Plan (500 minutes) (Addl $.39) Plan 4-National Plan (850 minutes) (Addl $.39) Plan 5-National Plan (1200 minutes) (Addl $.39) Plan 6-National Plan (2000 minutes) (Addl $.35) Plan 7-National Plan (3000 minutes) (Addl $.29) Quantity Free Free $ $ $ $ 29.00 99.00 79.00 79.00 $ 12.50 $ 31.97 $ 42.63 $ 53.30 $ 74.62 $ 106.61 $159.92 $213.23 D13AR114 WCAL LD10MINR CP3N00001 corpmac10 CP4N00001 corpmac10 CP5N00001 corpmac10 CP6N00001 corpmac10 CP7N00001 corpmac10 CP8N00001 corpmac10 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. Page 1 of 4 This form can be filled out online and pirnted or printed and filled out by hand. This label will not print with the form. Clear This Page Button will not print with this page. Battery Options / Telephone Accessories: Nokia Accessory Battery – $30.00 Note Phone Model 1261, 3360 or 3560 62981 6340 or 8265 62984 5165 60012 5165 Vibrating Battery - $34.00 Belt Clip - $5.00 Holster - $7.00 Swivel Leather Case -$12.00 60014 1261, 3360 or 3560 61895 5165 or 6340 60077 1261, 3360 or 3560 61783 6340 63104 1261, 3360 or 3560 61199 6340 62065 8265 62705 5165 60038 5165 External Antenna - $15.00 Hands Free Ear Piece - $15.00 SKU 61242 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 Hands Free Car Kit - $154.00 5165 or 6340 This form can be filled out online and pirnted or printed and filled out by hand. This label will not print with the form. Clear This Page Button will not print with this page. Page 2 of 4 62973 62975 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 This form can be filled out online and pirnted or printed and filled out by hand. This label will not print with the form. Clear This Page Button will not print with this page. Page 3 of 4 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 Telegence Comp Code: 20970 Use 5 digit order number as compass PO Compass ID: N04100031 Activate new service on BAN 361277381 Use last name and 5 digit Reference order number in user field Address questions to Ryan X432759 SOC may be specific to Direct Market This form can be filled out online and pirnted or printed and filled out by hand. This label will not print with the form. Revised 7/23/2003 Clear This Page Button will not print with this page. Page 4 of 4
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