AT&T Mobility

Change Request Form

For URGENT SERVICE IMPACTING requests, Please call our

National Business Services Department at 1-800-999-5445

Upon completion email request to:

Change Request will only be accepted by Authorized Order Placer’s

Any item marked with a (*) is a required field

Company Name/User Name: Date:

Foundation Account Number:PASSWORD:*

*(For your security, if your account has a password, you must provide it when making changes to your account)

Request Placed by:*Contact Number:*()-

Business Care Manager: Contact Number: ()-

CTN/Wireless Number*: ()- BAN/Account Number:

Market:

Service Level Information Changes

Note: Changes in this area will affect CTN/Wireless Number only. (If no changes are needed, leave field blank.)

Change Service User Name: Current Service User Name:

New Service User Name:

Change Service User Address:New Street Address:

Suite/Floor:

City: State: Zip Code:

Contact Number: ()-

Change Rate Plan:

Current Rate Plan: New Rate Plan: Monthly Fee:

Add/DeleteFeature/Promotion:

Add Feature: Add Feature: Add Feature:

Delete Feature: Delete Feature: Delete Feature:

Add Promotion: Add Promotion: Add Promotion:

Delete Promotion: Delete Promotion: Delete Promotion:

Billing Level Information Changes

Note: Changes in this area will affect the Billing Account. Leave field blank if no changes are needed.

(Check if billing address should be same as above)

Change Billing AddressAttn. Name:

Address:

City:State: Zip Code:

Contact Number: ()-

Move service to new FAN (foundation account number) FAN’s must be associated.

Change from Foundation Account #:toFoundation Account #:

Transfer service to existing local billing account number (consolidate)

Change from Account #:toExisting Account #:

Transfer service to new local billing account number (split on new account)

Change from Account #:toNew Account #: (will be created)

CBS Hierarchy Updates

Please select hierarchy updates

Add Child (Organization) orRename Level: From: to

Change the hierarchy assigned to each deviceChild (Organization) Name: New Value

UDL (Hierarchy Label) Updates

Add or Update UDL Values

Add Update

UDL1:

UDL 2:

UDL 3:

UDL 4:

Service Status Changes

Suspend Service (Select One Reason Below) Recurring charges for service continue to accrue while the service is suspended. If you wish to change the rate plan while service is suspended please fill out new rate plan information below:

Employee Change (120 days)*

Vacation/Seasonal (180 days)*

Equipment Problems/Upgrade (30 days)*

Stolen or Lost Equipment or Phone (30 days)**

Other:

Change Rate Plan during suspension:

Current Rate Plan:New Rate Plan:Monthly Fee:

* Service will be automatically reinstated after the marked day

** Service will be automatically cancelled after the marked day

Re-instate Service

Cancel Service (Select One Reason Below)

Please provide additional comments where indicated.

Employer Change

Competition Pricing/Promotion

Stolen or Lost Equipment or Phone

Poor Coverage

Poor Customer Service/Comment:

Billing Issue/Comment:

Bill Reprint Request

Note: After the first bill reprint, the fee is $5.00 per copy for duplicate copies, lost original or request for business purposes. If detailed billing is not active, we will not be able to provide for previous months. Bill reprint will be sent to the current billing address.

Please note: Due to FCC rules, Bill Reprints may only be sent to addresses that have have been on record for 30 days or longer. Bill copies may also be viewed on your Premier online site at any time.

Bill Reprint Request Reason:

Choose One: Incorrect Address Cingular Error Customer Disputes Bill Duplicate Copy

Month(s): Year:

Additional Comments

Request not handled through this email address

  • Equipment Warranty Exchange
  • New Equipment/Accessory purchases
  • Equipment Upgrades
  • New Activations

AT&T Mobility – National Business Services eTeam Revised 10/2/2018