NetworkVirginia Sprint LD Mod 10 Renewal Confirmation Page

Please complete the information below.Then, print this section out, sign, and fax it to the three contacts in this form.  After faxing is complete, follow the link at the bottom of this page to proceed to the service order form.

Before submitting this form, please be sure you have read and understand the Agreements with Sprint and with Verizon/Bell Atlantic which govern this service. Each of these documents is available on the World Wide Web at http://www.networkvirginia.net

By signing below, you acknowledge you have read these documents and agree to the terms and conditions contained therein.

If signature is other than ordering party, a letter of authorization is required from the ordering party.

   
Authorized Signature Date

Please provide the following information and submit copies via FAX to:


Sprint Virginia Tech
Attention: Brandy Haggar Attention: Vicki Wright
FAX #: 404-649-9349 FAX #: 540-231-2383
Phone #: 214-893-5954 Phone #: 540-231-3300



Customer Name
Installation Address Line 1
Line 2
City, State and Zipcode
Customer Contact Name
Customer Contact Phone

Click here to proceed to the service order form