Mobile Device Order Form

Requestor’s Contact Information

Name(Required)

First Last

Email(Required)

Trojan ID Number(Required)

Contact Number(Required)

Device User Name(Required)

First Last

User Email(Required)

User Trojan ID Number(Required)

Work Phone Number(Required)

Job Title(Required)

Organizational Unit(Required)

Division(Required)

Cost Center / Worktags(Required)

Enter N/A if not applicable

Are you making changes to a current mobile line?(Required)

Yes

No

Current Mobile Phone Number(Required)

Current Phone Make and Model(Required)

Choose a device to purchase.(Required)

Smartphone

Basic Phone

Mobile Broadband (Hotspot)

Other (specify devices not listed, including Tablet, Smartphone, etc.)

Quarterly Promotions

Lowest Cost Mobile Devices

Full List of Mobile Devices

NOTE: All of the devices and prices in both documents are updated quarterly.

Smartphone(Required)

Apple

Android

Phone Model(Required)

Basic Phone Model(Required)

Mobile Hotspot Model(Required)

Specify what device you need.(Required)

International Plan

Please put all countries you are traveling, departure date, return date, and mobile service features needed (talk, text, data).

Accessories / Features

Protection Case

Screen Protector

Car Charger

Wall Charger

Enable Hotspot

International Plan

Other (please specify below)

Miscellaneous Information

Captcha