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905 '12 6675 GLOBALSTAR CANADA 14:48: 18 11 - 19-2008 2 /7 <br /> Globalstar GLOBALSTARUSA Date` <br /> Time: <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 # <br /> Direct Fax. + 1 .905.712.6675 (Optional): <br /> Agent Ph . : Salesperson Phone: Fax or E-mail: <br /> Agent Fax. : Existing Globalstar USA Account or Satellite Phone M <br /> BILLING RESPONSIBILITY r- Business r ' Persona! XAGovl (non-GSA, GSA must use GSA form) <br /> Consumer Billing Contact: First: Rachel Last Name: Ivey <br /> 4 . <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 : rXSame as above 9 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: riyey@ ircgov .. Com Reason for purchase: <br /> (Email address /s mandatory to use the Quick Locate Service) <br /> How did you hear about us? r Web Site r Advertisement r Direct Mail r Trade Show rt Friend r Other <br /> ACTIVATION INFORMATION <br /> ESN : 11600403719 <br /> Satellite Phone Number: 863 - 203 - 2486 or SIM: <br /> Service Plan Name: Unlimited Loyalty Plan Phone User's Name: <br /> F7 FREE Voice Mail ($7.95/mo on Freedom50/Liberty 600) 177 VM Time Zone: <br /> Promotion Information Notes: <br /> Them is no monthly access charge For call forwarding services. Usage will be rated at 0. 15/6n USD plus applicable intemational long distance charges. <br /> r FAX SERVICE (1600) One Time/$50 - $39.95/Month <br /> r FAX SERVICE (2900) One Timel$50 • $39.95/Month <br /> F QUICK LOCATE SERVICE (Simplex) One Time435 - $34.95/Month r Sentinel r'- AXTracker <br /> (Please provide email address in Wling Address above) <br /> 17, TEXT E-MAIL VIA FAX OPTION — FREE <br /> USING E-MAIL VIA FAX MAY GENERATE SPAM. GLOBALSTAR USA IS NOT RESPONSIBLE FOR SUBSCRIBERrS USE OF THIS OPTION, <br /> SERVICE PAYMENT INFORMATION (Billing d Payments In U. S. Dollars) <br /> F7 Automatic Credit Card ( Preferred) fX Standard Billing P. O. Number if applicable : <br /> Card Number: Exp Date: Name on Card : <br /> t— 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 (GLOSALSTAR USA SATELLITE SERVICE AGREEMENT) AND/OR ANY THIRD PARTY SYSTEM <br /> (RESALE SATELLITE SERVICE AGREEMENT). A $50 ACTIVATION FEE, $50 SERVI PLAN CHANGE FEE, AND AN EARLY TERMINATION FEE MAY APPLY. <br /> Subscriber Signature : (( i <br />