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GLOBALSTAR USA
Service Activation & Credit Application Form
 |  |  | Customer to Fax back to Authorized Globalstar Dealer at: ________________________________
DEALER INFORMATION
Dealer Business Name: |  |  |  |  |  |  | Sales Rep:
Globalstar Dealer ID:
Business Phone: |  |  |  | Fax: |  |  | [NAME]:
APPLICANT INFORMATION
Applicant Type: |  | New: | Additional Line |  | Personal: | Business: | Government: |  | Rate Plan Change:
 |  | *If [NAME], provide other Satellite Phone #. or Account #:
Applicant Name:
Legal Business Name: (if applying as Business)
Applicant Address:
City: |  |  |  |  | State: |  |  | Zip Code:
Industry: |  |  |  |  |  | Job Title:
Business Phone: |  |  |  |  |  | Home Phone:
Facsimile: |  |  |  |  | [NAME]:
 |  |  |  |  | ([NAME] address is MANDATORY for service activation)
For a personal application, 2 of the following three pieces of identification are required:
Birth Date: |  |  | Driver's Licence No. |  |  |  | Social Security No.
Are you Tax Exempt? |  | Yes        No
(Please provide supporting documentation)
BILLING INFORMATION
Where do you want us to send your invoice? |  |  |  | Same as above: |  | Address Information Below:
Billing Address:
City: |  |  |  |  | State: |  |  | Zip Code:
A/P Contact(s): |  |  |  |  | Federal Tax ID:
MONTHLY AIRTIME INVOICE INFORMATION
Invoice: | Direct Debit from Checking: |  |  | (Please provide a void check with application)
Credit Card: | (Visa or [NAME] Only)
 | Credit Card No.: |  |  |  |  |  |  | [NAME]:
 | [NAME]:
 | Cardholder Signature:*
 | *Cardholder signature should belong to the applicant.
SERVICE INFORMATION (SELECT A PLAN & OPTIONAL SERVICES)
Device Type: | GSP-1700 [NAME]: |  |  | [NAME]: |  | GSP-2900 Fixed Phone: |  | Other:  _________________
Decimal ESN: |  |  |  |  |  | SAT PHONE NUMBER (MDN):
Monthly Service Plans | Orbit 10 | Orbit 40 | Orbit 100 |  | Orbit 200 | Orbit Unlimited | Additional Information:
Cost | $24.99/mo. | $39.99/mo. | $64.99/mo. |  | $99.99/mo. | $149.99/mo. | $50 activation fee collected at time of activation   - 12 month term applies to all rate plans   - Orbit 10/Galaxy 120 additional minutes - $1.99, all other plans $0.99   - All plans include Inbound SMS   - Voice calls will be billed first minute then 60 second increments   - Subscriptions on the same annual plan and the same account will      have the minutes pooled   - Unused airtime will not be rolled over to the next billing cycle
Minutes Included | 10 | 40 | 100 |  | 200 | Unlimited
Voice Mail | $4.99/mo. | $4.99/mo. | FREE |  | FREE | FREE
Express Data Compression | $4.99/mo. | FREE | FREE |  | FREE | FREE
Annual Service Plans | Galaxy 120 | Galaxy 480 | Galaxy 1200 |  | Galaxy 2400 | Galaxy Unlimited
Cost | $300/yr. | $480/yr. | $780/yr. |  | $1200/yr. | $1800/yr.
Minutes Included | 120 | 480 | 1200 |  | 2400 | Unlimited
Voice Mail | $60/yr. | $60/yr. | FREE |  | FREE | FREE
Express Data Compression | $60/yr. | FREE | FREE |  | FREE | FREE
The undersigned customer hereby acknowledges that he/she will abide by the "Globalstar Service General Terms & Conditions". The Terms & Conditions can be obtained from http://www.globalstar.com, your Globalstar Dealer or inside the product box.
Applicant Signature: |  |  |  |  |  |  | Date:
Globalstar Activations Department     Fax [PHONE]