REP: Staelle

Special Offer for Employees / Members of OSPE

Program
offered to employees of a corporate account.
YES
Yes, To help us process your order more efficiently,
please fill out this form and return it to the TELUS
authorised dealer whose coordinates figure
I would like to take advantage of this below.
offer.

BILLING INFORMATION
Last name: INIGO
First name: SANTHOSH
Address: 80 Acorn Place, Unit 40
City: Mississauga , Province: ON Postal Code: L4Z4E1

Shipping address: Same as above

If you have resided at your current residence for less than a year, please specify your previous address:
Address:
City: Province: Postal Code:

CREDIT INFORMATION
Home phone number: 905-502-9027
Work phone number: 647-470-6229
Date of birth (mm/dd/yyyy) : 08/15/1992
S.I.N. (optional):
Drivers licence number: I5935-51989-20815 Expires:2018/08/18
Credit card information: American Express MasterCard Visa- Yes
Credit card number: 4502200037664027 Expires:08/17 Sec #:021

Phone model: Samsung Galaxy S6 , 64 GB, Black colour

Rate plan chosen: Smart phone 60 - $60
Accessories: SIM CARD
Business name: OSPE Ontario Society of Professional Engineers
Please attach to this form a copy of your employee card or pay stubas proof of employment.
Employee number: 17619546

REQUEST TO TRANSFER A NUMBER FROM ANOTHER PROVIDER

Current phone number: 647-470-6229
Current service provider: Windmobile
Current service provider account number: DBC00082475443

Note: A TELUS service agreement will be forwarded to you and will require your signature. This agreement will include all information on this form.
Mobile services and prices included in this special offer for the employees are provided subject to the terms of service agreement TELUS, including
the terms of service listed in the service agreement, and are subject to the additional conditions below.
By signing below:
You acknowledge that you benefit from the special offer employees because you are a full time member of_______OSPE________________
who deals with TELUS.
You authorize TELUS to obtain information about your credit history. You authorize any, agency, consumer reporting company or any Credit company to
verify the information provided herein and you accept they exchange credit information with others at all times, including the information about your
payment history to TELUS.

Date: ___7 July 2015 Name (capital letters): Santhosh Inigo

Signature: ____________________________________________