Cell Phone Request Form
Full Name:
Supervisor
Name:
Phone Number:
(if upgrade)
Supervisor
Number:
Department:
Please Choose One of the Following:
New Cell Phone Request: Upgrade or Replacement:
Android/Samsung Android/Samsung
iOS/Apple iPhone iOS/Apple iPhone
Google/Pixel Google/Pixel
Other (Hotspot, etc.): Other (Hotspot, etc.):
Transferring Departments:
From: To:
Method of Payment:
Tribal Hard Dollars Grant Funded Purchase Order
GL#: PO#
Date:
Employee
Signature
Date:
Supervisor
Signature
Date:
Executive Director
Signature
OFFICE USE ONLY
Order Date: Receive Date:
Device: Other:
Mailroom Signature:
Eligible
Ineligible until .
TDS-31678 Rev 12/19