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
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