CONSENT TO ASSIGNMENT / ACCOUNT TRANSFER AND ASSUMPTION AGREEMENT
THIS CONSENT TO ASSIGNMENT/ACCOUNT TRANSFER AND ASSUMPTION AGREEMENT (The “Agreement”) is entered into as of____________ (“Effective Date”) by and between the current account owner ("Assignor") and the new customer (“Assignee”), and Alltel Communications, Inc. (“Alltel”).
In consideration of the mutual promises and covenants contained herein, the parties agree as follows:
The Assignor, as of the Effective Date, assigns, transfers and conveys to Assignee, all of Assignor’s rights, duties and obligations contained in Assignor’s wireless service contract (Assignor Contract) entered into by and between Assignor and ALLTEL together with all terms and conditions appurtenant thereto. The Assignee hereby accepts the assignment of all rights duties and obligations of the Assignor Contract and agrees to all terms and conditions of the Assignor Contract. Alltel hereby consents to the assignment as set forth herein. In consideration of Alltel’s consent, Assignor hereby releases any and all claims or liabilities, known or unknown related to the Assignor Contract. Alltel reserves the right, with or without cause, to refuse to accept ASSIGNEE as a subscriber and to refuse to extend service to ASSIGNEE. The ASSIGNOR is liable to Alltel for all debts and charges which have been incurred, whether billed or not, under ASSIGNOR’S telephone number until the Effective Date of this Agreement.
MOBILE TELEPHONE NUMBER (S) TO BE TRANSFERRED: _________________ ________________ _________________
ASSIGNEE (NEW CUSTOMER) INFORMATION (Required)
ASSIGNEE authorizes ALLTEL to employ any credit bureau or other investigative agency to investigate statements or data obtained from ASSIGNEE or any other person pertaining to ASSIGNEE’S credit and financial responsibility.
IF ASSIGNEE HAS EXISTING ACCOUNT: PROVIDE ACCT # OR MOBILE #: ___________________________
WILL THE MOBILE NUMBER INHERIT THE ASSINGEE’S EXISTING RATE PLAN: Y_____ N_____
IF NO, SPECIFY NEW RATE PLAN: _____________ ______MONTHLY RATE: $__________________
IF ASSIGNEE IS ESTABLISHING A NEW ACCOUNT COMPLETE THE FOLLOWING INFORMATION:
NEW RATE PLAN (if applicable) _________________ MONTHLY RATE: $ ________________
Name: _____________________________ DBA: _____________________________________
Mailing Address: ______________________________________________________________________
City, State, Zip: ________________________________________________________________________
Physical Address (If different): ____________________________________________________________
Home Phone (Landline number Only, Wireless number will prolong the process): ______________________
Business Phone: ________________________
Contact Name (If corporation): ____________________________________________________________
Alternate User (Person authorized to inquire about account): _____________________________________
PERSONAL CREDIT INFORMATION (Required for Personal Accounts)
Date of Birth: _____/_______/_______ Social Security Number: ____________________________
Driver's License: _______________________________ State: ______________________
BUSINESS CREDIT INFORMATION (Required for Business Accounts)
Date of Incorporation: _____/______/______ City & State Inc.: ___________________________________
Federal ID Number: ___________________ D&B Number: ______________________________
CREDIT/DEPOSIT INFORMATION ONLY (AGENT MUST PROVIDE INFORMATION BELOW)
Credit Date: ______/_______/________ Credit App. #: ____________________ Credit Class: __________
PLEASE CIRCLE PAYMENT METHOD: Credit Card or Check
Creditcard #: ___________________________ Type: ____________ Exp. Date: _____/_______/_______
3 Digit Security Code (back of the card):______________
Bank Routing #: ____________________Bank Acct #:____________________ CIRCLE ONE: Checking or Savings
"I acknowledge that I have read, understand and accept the terms and conditions of this Agreement.”
ASSIGNOR (CURRENT CUSTOMER): ASSIGNEE (NEW CUSTOMER):
______________________________________________ _____________________________________________________
(Signature) (Signature)
______________________________________________ _____________________________________________________
(Printed Legal Name) (Printed Legal Name)
Sales Agent’s Name_____________________________________ E-mail Address: ________________________________________
Fax #: __________________________Phn.#____________________________Sales ID _____________________________________
(Please Print)
Once complete AGENTS may fax to 501-905-5895
All change of responsibility forms received by Alltel
retail stores should be processed at that location
CONSENT TO ASSIGNMENT / ACCOUNT TRANSFER INSTRUCTIONS
ASSIGNOR
The ASSIGNOR (the customer whose name appears as the owner of the account) needs to do the following:
1. Sign this Agreement under “ASSIGNOR/CURRENT CUSTOMER.”
2. Fill in the “ASSIGNEE” line on the top portion of the application with the “ASSIGNEE’S name.
3. Fill in the "TELEPHONE NUMBER(S)" line in the top portion of the page.
4. Forward the application to the person who will take over ownership of the account, the ASSIGNEE.
ASSIGNEE (NEW CUSTOMER)
The ASSIGNEE (the customer who is assuming ownership of the account) needs to do the following:
1. Verify that the "ASSIGNEE" line on the top portion of the application is correct.
2. Verify that the "TELEPHONE NUMBER(S)" line on the top portion of the application is correct.
3. Complete the "ASSIGNEE (NEW CUSTOMER INFORMATION)" section. If the ASSIGNEE is an individual, please fill out "PERSONAL CREDIT INFORMATION." If the ASIGNEE is a business, please fill out "BUSINESS CREDIT INFORMATION."
4. Sign the Consent to Assignment/Account Transfer Authorization and Assumption Agreement at the bottom under "ASSIGNEE (NEW CUSTOMER)."
After completion, please return the form to the address below or a local Alltel retail store for processing. INDIRECT AGENTS may fax the COMPLETED form to 501-905-5895.
Return address:
Alltel Communications, Inc.
1 Allied Dr, 1269 – B4F05-NB
ATTN: Change of Responsibility Department
Alltel retail stores will process all change of responsibility forms received at their location.
IMPORTANT NEW CUSTOMER INFORMATION
1. Please fill in all of the indicated blanks on the form. Failure to do so will only result in the delay of your request.
2. No changes can be made to the account until the Alltel Change of Responsibility Department receives the completed form. Please return the completed form to your Sales Agent or mail to the address provided above.
3. You will be notified by phone or mail if more information is required.