0160-12 - Verizon Wireless - ContractPC)
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Please refer to Corporate Liable Authorization Form Instructions. Please complete this form and return it to Verizon Wireless via e-mail by saving a copy to
your desktop and sending it as an attachment to: POCUDdates(dVerizonWireless.com
The person signing this form represents and warrants that they have the authority to bind the Company/Customer identified below and requesting that Verizon
Wireless add/dele ut rized Contacts as noted below. If returning via e-mail please type name.
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Signature: �r/p� Date:06-01-2012
Name: Brandy Rinearson
Title: City Clerk
Company Name: City of Port Orchard
Company Address: 216 Prospect Street
City: Port Orchard State: WA ZIP: 98366 1
Fed. Tax ID #
D&B #
Contact Phone Number: 360-876-4407 Contact E-mailbrinearson@cityofportorchard.us
Do you want to add yourself as an Authorized Point of Contact? Check this box if YES. I ❑ I If YES, Please designate your Role:
Please enter the Account Number and/or a Mobile number for company:
Add/Delete
Name
Title
AUTHORIZED11. • -•
Role Phone # Emall Address
Mailing Address
Add
Clete
Rhiannon Fernandez
Deputy Clerk
Clerk 360-876-7024
rernandez(cDeitvofportorchard.us
216 Prospect St, Port Orchard, WA 98366
216 Procpeet St, Port Orchard, WA 98366
Patty Kirkpatrick
Former City
Clerk
None 360-876-4407
To maintain flexibility for your business, the above changes will not impact your My Business online portal authorized
personnel. Please access the self serve portal directly to make changes to your online portal authorized personnel.
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I. Authorized Signature
The person signing this form represents and warrants that they have the authority to bind the Company/Customer identified on the form and requesting that
Verizon Wireless add/delete Authorized Contacts as noted in the form.
=lease complete this section in its entirety and sign, if returning via e-mail please type your name in the Signature Field.
II. Authorized Contacts
Verizon Wireless requires that its business customers designate Authorized Contacts or Point of Contacts (POC's) on their accounts. An Authorized Contact /
POC is an individual who is granted authority to act on behalf of the company for all matters contemplated by your company's Major or National Account
Agreement or relating to your company's account(s).
Verizon Wireless needs an individual authorized to legally bind your company to identify as a new Authorized Contact or Point of Contact (POC) to be added to
your accounts. Each contact must be assigned a level of authority on your company's accounts.
The following roles are available. Please identify a role for each Authorized Contact/POC:
• Administrative Role. These POCs are authorized to add, delete and change POCs as well as perform any other transaction on the account.
• Maintain Role: Allows access to the same transactions as the administrative role with the exception of adding and deleting other POCs
• Buy Role: These POCs are authorized to initiate new activation requests, add/change/delete services, port lines and purchase or upgrade equipment.
• View Role: Allows access to account such as balance information, request bill reprints, make a payment, price plan inquiry, and request technical support
• MIyPOC (For My Business Users Only): This POC is responsible for the customer's utilization of the My Business Account application. Unlike the other
roles, only one MyPOC can be added to a profile/contract, if you are deleting your current MyPOC from the authorized point of contact list please
designate a new MyPOC on the form.
Please complete the Authorized Contacts section advising to Add/Delete/Update POC, the POC name, Title, designated Role, Phone# and/or Email
address, and mailing address.
III. Email Domains
Verizon Wireless utilizes your company owned email domain as a validation to verify employment when adding employee liable end user discounts.
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