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9057426675 GLOBALSTAR CANADA 14:48: 18 11 -19-2008 217 <br /> 11 / 62 <br /> Date: <br /> Globalstar , GLOBALSTAR USA <br /> Satellite Service Agreement <br /> Globalstar Customer Care <br /> + 1 .905 .712.7197 Distributor ID: Distributor Name: Lead # (if applicable): <br /> +1 ,877 .GLBLSTAR <br /> 800 Fax + 1 .888.604.7517 Sales Professional Name: Sales ID 0 <br /> Direct Fax: + 1 .905.712.6675 #( pti onal) : <br /> Agent Ph .: Salesperson Phone: Fax or E-mail: <br /> Agent Fax.: Existing Globalstar USA Account or Satellite Phone #: <br /> BILLING RESPONSIBILITY r-. Business r" Personal XAGovl ( non-GSA, GSA must use GSA form) <br /> Consumer Billing Contact: First: Rachel Last Name: Ivey <br /> Business Name: Indian River County Dept . of Emergency Services <br /> PHYSICAL ADDRESS <br /> Street Address: 4225 43rd Ave . City: Vero Beach <br /> State/Prov./is: ZIP/Postal: 32967 - 1671 Country: United States <br /> BILLING ADDRESS : I7%Same as above IX Federal Tax Exempt (must provide documentation) <br /> Street Address: City: <br /> State/Prov./Is: ZIP/Postal: Country: <br /> Business Phone : Home Phone: Fax: <br /> Date of Birth : Social Security/Tax ID #: <br /> Driver's License/ID/Passport (circle one) M <br /> Employer. Industry Segment: <br /> E-mail address: ^ rivey@ircgov . com Reason for purchase: <br /> (Small address is mandatory to use the Quick Locate Service) <br /> How did you hear about us? IT. Web Site r.: Advertisement r' Direct Mail t` Trade Show r Friend r~ Other <br /> ACTIVATION INFORMATION <br /> ESN : 11600400627 <br /> Satellite Phone Number. 863 - 203 -- 2487 or SIM : <br /> Service Plan Name: Unlimited Loyalty Plan Phone User's Name: <br /> f` FREE Voice Mail ($7 .95/mo on Freedom50/Liberty 600) r VM Time Zone: <br /> Promotion Information Notes: <br /> There is no monthly access charge for call forwarding services, Usage will be rated at $0. 1510in USD plus applicable international long distance charges. <br /> F, FAX SERVICE (1600) One Time/$50 - $399-95/Month <br /> F-� FAX SERVICE (2900) One Time/$50 - $39.95/Month <br /> F QUICK LOCATE SERVICE (Simplex) One Time/$35 - $34.95/Month r- Sentinel I"' AXTracker <br /> (Please provide email address m &Ilinlg Address above) <br /> C TEXT E-MAIL VIA FAX OPTION — FREE <br /> USING E-MAIL VIA FAX MAY GENERATE SPAM. GLOaALSTAR USA IS NOT RESPONSIBLE FOR SUSSCRISER'a USE OF THIS OPTION, <br /> NERE <br /> SERVICE PAYMENT INFORMATION (Billing & Payments In U. S. Dollars) <br /> 7 Automatic Credit Card (Preferred) t'X Standard Billing P.O. Number if applicable : <br /> Card Number: Exp Date: Name on Card: <br /> 7 Direct Debit ( US Banks only, except Bank of America) r-` Saving r Checking (Voided check required) <br /> Routing Number Account # Bank Name: <br /> BY SIGNING THIS FORM, YOU'RE AGREEING TO THE GLOBALSTAR USA, LLC TERMS AND CONDITIONS FOR GUSA SERVICE, INCLUDING ANY SERVICE PURCHASED <br /> WITH A RENTAL UNIT, THAT IS USING THE GLOBALSTAR SYSTEM (GLOBALSTAR USA SATEL TE SERVICE AGREEMENT) ANDIOR ANY THIRD PARTY SYSTEM <br /> t' <br /> (RESALE SATELLITE SERVIC EEMENT). A $50 ACTIVATI4 FEE, S50 VICE PLAN CH GE FEE , AND AN EARLY TERMINATION FEE MAY APPLY. <br /> Subscriber Signature: n <br />