Verizon Cell Phone Request Form 

 

This form allows you to request a new cell phone or accessory or change your cell plan.
Please submit information for only one cell number at a time.

 

Contact Person Making Request:
Contact Person's Email:
Contact Person's Phone Number:
Department Account Code:

 
Types of Service Requested:
New Line Cancellation
Repair/Replace Lost or Stolen
Accessories (See List Below)

Plan Requests:
Number of Minutes Needed:
Caller ID Needed
Voicemail Needed
Nationwide Plan Needed

Accessories:
Type of Phone if Existing: 
Car Charger Leather Case
Hard Clip for Belt Desk Charger
Extra Battery Extended Life Battery
Head Set Car Kit
Other:

Questions or Comments: