Rethink Possible Form Version 7/08/2010 2 3 4 5 6 7 8 9 10 2 3 4 5 6 7 8 9 10 AUTHORIZATION TO CHARGE TO WIRELESS ACCOUNT HANDSETS & ACCESSORIES COMPANY NAME ABI NUMBER SALES REPRESENTATIVE Little Soint Jomes Astrid. Roman CHARGE TO ACCOUNT HANDSET PURCHASE QUANTITY MODEL / SIM CARD UNIT PRICE M1SC/OTHER TOTAL PRICE I I-Phone 3gs 8gb $4999 340-201-9533 $4999 I-Phon 3gs 8gb $4999 340-244-4774 $4999 I I-Phone 3gs 8gb $4999 340-244-8564 $49.99 I I-Phone 3gs 8gb $49.99 340-244-8565 $49.99 I I-Phone 3gs 8gb $49.99 340-244-8566 $49.99 I I-Phon 3gs 8gb $4999 340-642-0905 $49.99 I I-Phone 3gs 8gb $4999 340-642-0906 $49.99 I I-Phone 3gs 8gb $49.99 340-642-6232 $49,99 I I-Phon 3gs 8gb $49.99 340-642-6242 $49.99 I I-Phone 3gs 8gb $49.99 340-642-7258 $49.99 COMPANY • DATE ACCOUNT NUMBER 6100 Red Hook OU 845n VI 12-Apr-I I 287004751025 TOTAL CHARGE TO ACCOUNT ACCESSORIES PURCHASE QUANTITY MODEL / OESCRIPTION UNIT PRICE MISC/OTHER TOTAL PRICE $0.00 $0.03 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 30.00 $at» $499.90 NAME Ann Rodrigvez. TRE TOTAL TAX TOTAL APAOUNT TO BE CHARGE AUTHORIIEO SIGNA1U Accounh Poyables CONTACT PHONE NUMBE $0.00 34.99 340-775-2525 The compcny oulhorizes the chmge ot the following handseh ond occessories lo Ihe wkeless ocCOunt deSCribed (t ove. The company is ItAly bot* for the told omount on Ilt form. The compony ezpicitly recognizes ond accepts the tonns and concSlions induded in The Wireless Service Agreement ond The Fnuivnant Mitirm Porkw on the back of Ihis dOCUTOfit EFTA01221212