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Please correct the fields below:

Mobile Phone Request

1

What is your name?

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2

Who will be the user of this mobile phone?

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3

What is the mobile phone user's Department?

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4

What is the mobile phone user's Division?

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5

What is the budget billing account for this phone request?

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6

Is there an existing mobile phone number already issued to the user?

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Is there an existing mobile phone number already issued to the user?
7

What device is being requested for the mobile phone user?

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What device is being requested for the mobile phone user?

What time of day will this mobile phone primarily be used?

8

6 AM - 5 PM

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6 AM - 5 PM
9

5 PM - 9 PM

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5 PM - 9 PM
10

9 PM - 6 AM

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9 PM - 6 AM
11

Is the mobile phone user on call 24 hours a day, 7 days a week?

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Is the mobile phone user on call 24 hours a day, 7 days a week?
12

Will the mobile phone stay in one user's possession 24x7, rotate with another staff member, and/or at the end of the day remain in the office until the next business day?

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Will the mobile phone stay in one user's possession 24x7, rotate with another staff member, and/or at the end of the day remain in the office until the next business day?
13

Is the camera feature a requirement of the mobile phone and if so, describe its use and urgency? (For the Pantech Breeze, the mobile phone user will need to purchase a microSD card and card reader to download pictures from the device.)

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Is the camera feature a requirement of the mobile phone and if so, describe its use and urgency? (For the Pantech Breeze, the mobile phone user will need to purchase a microSD card and card reader to download pictures from the device.)
14

During the business day, will the mobile phone user travel outside of city limits?

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During the business day, will the mobile phone user travel outside of city limits?
15

Which city locations need to be communicated from but cannot because landline phones do not exist?

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16

Will the mobile phone interface (text, alerts, GPS, TeleNav Track etc.) with a system or application, and if so, how (define its purpose and frequency)?

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Will the mobile phone interface (text, alerts, GPS, TeleNav Track etc.) with a system or application, and if so, how (define its purpose and frequency)?
17

Is the mobile phone user on the EOC Committee, and if so, define roll?

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Is the mobile phone user on the EOC Committee, and if so, define roll?
18

Please provide justification for the phone, voice plans other than the city default, and data plan, if applicable, below:

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19

Please include additional comments below:

Thank you

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