Order Form for Telus Corporate EPP Plan

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Date

Employer Name & Employee Number (If Applicable)*

Where do you work or which association are you a member of?

Are you currently with Telus?*

Are you adding a New Subscriber?*

Are you Porting in a number?*

Number to be Ported in:*

Current Service provider account details:*

Account Number from existing service provider

Phone Make and Model*

e.g iPhone XR 64GB Black, Samsung Galaxy S10+ Black etc.

Rate Plan*

e.g. Peace of Mind 10GB etc.

Billing Information

Title*

Mr.Mrs.Ms.

Name*

First NameLast Name

Existing Telus Account Number or Phone Number*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

E-mail*

Choose 4 Digit Pin (Cannot Start with 0)*

You will need this to call in to Telus or create an online account!!

Personal Credit Check Information

Valid Photo ID*

Expiry Date*

Secondary ID*

Expiry Date*

Date of Birth mm/dd/yy*

Comments

Ship it to me (Free Shipping)*

Ship it to me (Free Shipping)I will pick it up

Connection Fee*

I understand that TELUS will charge me a $60 Connection Fee on my next invoice.

Trade In

Are you trading in your old phone for extra cash back?

Extended Warranty