Form 13

Pager Order Form

Billing Information:

Department Contact Name: ___________________________________ Contact Number:______________

User Name (if different from contact name):________________________________

Department: ____________________________

Index: _________________ Activity Code:_____________

Pager Number:________________________  (lost, stolen, exchanged, upgrade, new number)

Pager Information:

Numeric ______(at $2.25 per month) or Alphanumeric ______(at $4.95 per month)

Pagers are usually in stock and can be picked up from our office.

Please Fax this order form to 541-346-5845

If you have any questions, please contact Lori Hansell  at 346-1035