PIN Code:_____________________  SPRINT PCS-RADIO SHACK

Date:________________________________________________________________

Name:_______________________________________________________________

Address:_____________________________________________________________

City:_______________________________  State:_______   Zip:_________________

DOB:________________________________________________________________

Social Security #:_______________________________________________________

Home Phone #: ____________________Alternate Phone #: _____________________

Driver's License # ___________________________    State: ____________________

Business Name:_______________________________________________________

Business Address:____________________________ Phone:___________________

Customer
Signature
for Credit Check::__________________________________ Date:_______________

___________________________________________________________________
To be filled in by sales associate.

Approval Number:: _______________________ Number of lines: ________________

Deposit?       No:______________ Yes, Amount: _____________________________

Sales Associate Name : ________________________________________________

____________________________________________________________________

Phone Selection: __________________________ Sprint Plan:___________________

Sold:             Will Return:              Ticket No:_________________________________