RETAIL ORDER FORM First Name Last Name Company Name Address City State Florida New Jersey New York Other Please Enter Other State Zip Email Address Contact Phone Alternate Phone Product Choices $ 59.95/month - UNLIMITED TALK & TEXT All-in-One Plan $ 39.95/30 day Service - UNLIMITED TALK & TEXT Basic $ 79.95/month - UNLIMITED EVERYTHING All-in-One Plan $199.99 - SAMSUNG SCH-i730 VERIZON $149.99 - Blackberry 8703e New-in-the-box $149.99 - Motorola Q New-in-the-box $229.99 - Samsung Ace New-in-the-box $ 9.95/month - Pay-As-Your Go w/ Rollover Minutes $ 19.95/month - Pay-As-Your Go w/ Rollover Minutes $ 29.95/month (plus $19.95 one-time set-up fee) - Unlimited US/CAN Service $ 29.95/month (plus $19.95 one-time set-up fee) - Unlimited Brazil Service $ 39.95/month (plus $19.95 one-time set-up fee) - Toll Free Unlimited Service $349.95 - VoiP Video II Phone & Unlimited US/CAN Service $299.99 VoiP Video Phone & Unlimited US/CAN Service $ 99.99 - VoiP Basic w/Phone & Unlimited US/CAN Service $ 99.99 - VoiP Basic w/Adapter & Unlimited US/CAN Service $ 29.95 (plus $19.95 one-time set-up fee) - VoiP X-Lite (FREE) & Unlimited US/CAN Service $ 69.95 - MyiFLASH Drive Additional @ $39.95/month 1 2 3 4 5 6 7 8 9 10 $ 25.00/per line Activation Fee $ 15.00/one-time Cell Phone Programming Fee $199.99 Samsung i760 Verizon Network Only $149.99 - Blackberry 8703e Verizon/Sprint Netork $149.99 Motorola Q Verizon/Sprint Network $229.99 - Samsung Ace SCH i325 $ 12.95/month - Additional USA/CAN Phone Line/DID $ 19.95 Set-up Fee - Port Existing Phone Number (Land-Lines Only) $ 19.95 Set-up Fee - Fax to Email $ 9.95/month - Toll Frree Number Name On Credit Card Credit Card Number Type Of Credit Card Visa M/C American Express Other Ohter Credit Card Type Expiration Date Three-Digit CV2 Direct Sales Associate Name/ID# I Agree to the terms and conditions of this order with TMI & Associates, Inc

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