VERIZON CONTRACT NEW MEMBERS
I understand this cellular phone service is a benefit provided to me as a member of the Arizona Police Association (APA). If my status as a member should change, I further understand I must forfeit this service and assume personal responsibility for my phone account within 14 days. Further, in the event my membership terminates, I will be responsible for any charges due and owing at that time. I agree to guarantee prompt payment of my Verizon Wireless account by securing amounts due to be charged to my credit/debit card monthly; if my account were to go 30 days past due Verizon Wireless will suspend/cancel services and require full payment to resume services.   
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Name *
email address *
Agency/Station *
Phone number(s) to transfer
Desired phone plan *
Required
If you are transferring a Smart Watch, list the IMEI number and phone number of the watch
Please list the following information from the account you are transferring lines from: 
1. Cell phone provider
2.  Name on Current Billing Statement
3.  Full Billing Address on Statement
4. Account Number
5. PIN or Transfer Number (only if a Non-Verizon account)
Billing Address For Your New Verizon Account *
Your Email Address for Your New Verizon Account *
If ordering devices, please list the phone number and the device (model, storage size, and color) for each line
If you are wanting to use your existing device, and porting over from another provider, please list the IMEI number of the device. Please note, not all devices will work on the Verizon government account, we will notify you if it will not work. If it does work, a new SIM card will be ordered for you. 
Shipping Address for the new device(s) or SIM card for existing device number port:
Street Address
City
State
Zip Code
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