ࡱ>  FbjbjO O X-a-a'D D 8T>~&P""""D$%%%%%%%$4(*\%E%""8&X""%%:$,-%"[^$ %N&0~&$RB+B+-%B+-%%%E~&B+D d: Employee End User FormAs a benefit of your employment with your organization, you may be eligible to purchase Verizon Wireless equipment and wireless service at a discount. The quickest way to register for an employee discount is use our online registration by visiting us at  HYPERLINK "http://www.verizonwireless.com/getdiscounts" www.verizonwireless.com/getdiscounts. In the event your employer is not registered in our online system, please complete and fax this form. If you are FAXING the formStep 1 The Verizon Wireless account must be in your name. Step 2 You must read and agree to the terms of this form by signing below. Step 3 You must provide proof of employment by photocopying your employee ID or pay stub.* Step 4 Fax this form and your proof of employment to  FORMTEXT 1-800-711-7788  You may be able to register your line for a discount at www.verizonwireless.com - Choose Employee Discounts You understand that your employment with the organization identified below may permit you to obtain wireless service (on eligible calling plans with a monthly access fee of $34.99 or higher)** and equipment at a discount provided you meet the other requirements set forth in the Verizon Wireless Customer Agreement. You understand that this discount is based on your organizations agreement with Verizon Wireless, or the Verizon Wireless Government Employee Discount Program, and that from time to time, your discount rate may be adjusted in accordance with your organizations agreement or changes to the Government Employee Discount Program. You understand that the terms and conditions of the Verizon Wireless Customer Agreement apply to this employee discount program. You agree that, if you are otherwise subject to an Early Termination Fee, you will not be permitted to terminate your service without being liable for such Early TerminationFee solelybecause ofa change in your ratesresulting fromeither a discount adjustment to which your organization has agreedor, if applicable to you,changes to the Government Employee Discount Program. You understand that certain information relating to your service, including your name, your mobile telephone number and total monthly charge may be released to your organization (does not apply to Government Employees). Verizon Wireless reserves the right to require proof of your employment (Company ID badge or pay stub). If a review of your employment status reveals that you are not, or are no longer, an employee of your organization, Verizon Wireless reserves the right to remove this discount and move you to a commercially available calling plan or to a non-discounted service plan for the remainder of your line term commitment.  FORMCHECKBOX  By signing this form or, if returning via e-mail, by clicking the box to the left, you understand and agree to the terms and conditions above as well as the terms and conditions of the Customer Agreement. Employee Signature:  FORMTEXT      Print Name:  FORMTEXT       Date:  FORMTEXT      Organization Name:  FORMTEXT      Mobile Telephone Number: ( FORMTEXT      ) FORMTEXT      - FORMTEXT       Print Email Address:  FORMTEXT      Reprint Email Address:  FORMTEXT      Phone Number where we can contact you (if different from your Mobile Telephone Number): ( FORMTEXT      ) FORMTEXT      - FORMTEXT       If you have additional lines on your account, please list them below ( FORMTEXT      ) FORMTEXT      - FORMTEXT        ( FORMTEXT      ) FORMTEXT      - FORMTEXT        ( FORMTEXT      ) FORMTEXT      - FORMTEXT        ( FORMTEXT      ) FORMTEXT      - FORMTEXT       *Government employees (or employees that do not possess or cannot fax an employee ID) may fax a pay stub no greater than 30 days old (please delete account and salary information) **Up to five (5) of your Verizon Wirele  Q R S w x 8 9   ! " 1 2 4 6 c e E )+ub%jwh(^CJOJQJU^Jh(^CJOJQJ^Jjh(^CJOJQJU^Jh(^CJOJQJ^Jh(^CJaJ h(^CJH*h(^OJQJ^Jh(^CJmHnHujh(^CJUh(^5CJ\h(^0JCJjh(^CJUjh(^CJU h(^CJh(^&  $If`$a$jkd$$Ifl0*0*   064 lalp $If 9 4 5 $$Ifa$rkdd$$Ifl4*+   0@A684 laf4p 5 6 ~u $$Ifa$ $$Ifa$xkd$$Ifl4m0*@+80@A64 laf4 ,-wnZMZMZM $^`a$$ & F ^`a$$^a$kd$$Ifl40*@+8   0@A64 laf4p ,-   $$Ifa$$a$$ & F ^`a$ $^`a$$ & F ^`a$   (*>@BLNTZ\^`tvx䬌yfVjhXCJOJQJU^J%jh(^CJOJQJU^J%jh(^CJOJQJU^Jh(^CJOJQJ\^J%j1h(^CJOJQJU^Jh(^;CJOJQJ\^J*jh(^CJOJQJU^JmHnHu%jh(^CJOJQJU^Jjh(^CJOJQJU^Jh(^CJOJQJ^J!R~~ $$Ifa$xkd_$$Ifl4    0L4*      0    +64 laf4~ $$Ifa$xkd$$Ifl4    J0L4*    0    +64 laf4$&(2468LNPZ\^`tvx ɿɚɿɚɿɿxɚk׿ɿZɚ׿!j' h(^OJQJU^Jh(^5;OJQJ^J!j h(^OJQJU^J!j h(^OJQJU^J&jh(^OJQJU^JmHnHu!j h(^OJQJU^Jh(^OJQJ^Jjh(^OJQJU^Jh(^OJQJ^JaJh(^CJOJQJ^Jjh(^CJOJQJU^J#*ekdq $$Ifl4    GL*+  0    +64 laf4  !$Ifekd_$$Ifl4    kL*+  0    +64 laf4   "$.024  $&(2468LNPZ\ 4񶩶vgh(^5OJQJ\^JaJ!j h(^OJQJU^J!jU h(^OJQJU^J!j h(^OJQJU^Jh(^5;OJQJ^Jh(^OJQJ^JaJ&jh(^OJQJU^JmHnHu!j h(^OJQJU^Jh(^OJQJ^Jjh(^OJQJU^J$24|xkd $$Ifl4    G0L*  0    +64 laf4  !$Iftkd$$Ifl4    9L*+    0    +64 laf4p $$Ifa$ekd=$$Ifl4    GL*+  0    +64 laf4468BDFH\^`jlnpඥඔඃra!j h(^OJQJU^J!jh(^OJQJU^J!j$h(^OJQJU^J!jh(^OJQJU^J!j<h(^OJQJU^Jh(^OJQJ^Jh(^OJQJ^JaJ&jh(^OJQJU^JmHnHujh(^OJQJU^J!jh(^OJQJU^J&.0Dvxkd$$Ifl4    L0L*  0    +64 laf4$If  !$If.046JLNXZ\^rtv  νΘ·ve!j"h(^OJQJU^J!jh(^OJQJU^J!j:h(^OJQJU^J!jh(^OJQJU^J&jh(^OJQJU^JmHnHu!jRh(^OJQJU^Jh(^OJQJ^Jh(^5;OJQJ^Jh(^OJQJ^JaJjh(^OJQJU^J'$&(24DFHJLD[DdEeEfEEEEEE񶩛{sm_M_#jh(^CJOJQJU^JaJh(^CJOJQJ^JaJ h(^CJh(^CJaJh(^OJQJ^JaJUh(^OJQJ^Jh(^OJQJh(^CJOJQJ^JaJh(^5;OJQJ^Jh(^OJQJ^JaJ&jh(^OJQJU^JmHnHu!jh(^OJQJU^Jh(^OJQJ^Jjh(^OJQJU^JDFH|  !$Ifxkd $$Ifl4    L0L*  0    +64 laf4HJeE  !$Iftkd$$Ifl4    L*+    0    +64 laf4p ss lines are eligible to receive the employee discount & they must be on the same account. Family Share Secondary lines are NOT eligible for discounted rates. Visit My Account at www.verizonwireless.com or contact Verizon Wireless Customer Service at 1-800-922-0204 if a price plan change is required. 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