Demo Airtime & Equipment Set-Up Form: Iridium 9704 Module

Unique ID

Date Submitted*

Name of Individual Completing this Form*

First Last

Email of Individual Completing this Form*

Company Administration Information

Company Name*

Company Address/Bill To*

This address will appear on invoices and should match your Iridium signed agreement.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Ship To Address*

Same As Bill To Above

Other (add below)

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number for Shipments*

Additional Ship To Address*

*Only for use if two ship to locations are needed on the account

Yes (add below)

Ship To Company Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number for Shipments*

Resale Tax Certificate Required*

PRIMARY OR ALTERNATE 'SHIP TO' ADDRESS IS IN THE UNITED STATES, PLEASE ATTACH COPY OF RESALE CERTIFICATE FOR EACH STATE TO WHICH GOODS WILL BE SHIPPED. CERTIFICATE MUST BE ISSUED TO “IRIDIUM SATELLITE LLC, 8440 S. RIVER PARKWAY, TEMPE, AZ 85284” BY THE IRIDIUM SERVICE PARTNER. IF THE 'SHIP TO' LOCATION IS TO A COMPANY OTHER THAN THE AUTHORIZED SERVICE PARTNER, SUCH AS A DEALER, A RESALE CERTIFICATE IN THE NAME OF THE SERVICE PARTNER IS STILL REQUIRED. Press CHOOSE FILE to search for and attach a document (PDF only):

Accepted file types: pdf, Max. file size: 768 MB.

ORDER PLACEMENT AND SHIPPING CONTACT

Contact Name*

First Last

Email*

Phone*

Small Freight Carrier*

Small Freight Account #*

Large Freight Carrier*

Large Freight Account #*

Partner Agreement Allows for Hardware Purchase of (mark all that apply):*

9602/9603 SBD

9680 Edge

9690 Edge Pro

9640 Edge Solar

9704 Certus

9770 SFX

9523 LBT

N/A

SERVICE DESK

Technical Contact Name

First Last

Technical Contact Email

Country of Citizenship

INVOICING AND BILLING CONTACTS

Please list 2 separate contact names and emails.

Contact Name (1)*

First Last

Email*

Iridium Equipment & Airtime Invoices will be sent to this address

Phone*

Contact Name (2)*

First Last

Email*

Iridium Equipment & Airtime Invoices will be sent to this address

Phone*

AIRTIME PROVISIONING

CDR TYPE*

Call Detail Records are offered in two formats. Please select you preferred format:

TAPII

NA TAPII

SPNet Pro Administrator*

Email address must be a specific person versus a general mailbox.

First Last

Email*

Email address must be a specific person versus a general mailbox.

SPNet Pro Notification Contact*

First Last

Email*

PTT Command Center Administrator

*Only required if contracted to provide Iridium PTT services

First Last

*Only required if contracted to provide Iridium PTT services

IRIDIUM FOR PARTNERS (IFP) SUPER ADMIN CONTACT

Iridium for Partners (IFP) is the Iridium partner portal and serves as an online repository where partners can access valuable resources.

Super Admin Contact Name*

First Last

Contact Details*

Email Phone Country of Citizenship

IRIDIUM FOR PARTNERS (IFP) MARKETING CONTACT

Marketing Contact Name*

First Last

Contact Details*

Email Phone Country of Citizenship

EXPORT COMPLIANCE CERTIFICATION

The officer or employee named below hereby certifies that:
Company is eligible to receive exports of United States-origin products, materials, services, technical data, hardware and software. Company shall comply with all applicable export control laws and regulations and shall not directly or indirectly export, re-export, resell, ship or divert any product, material, service, technical data, hardware or software furnished to Company by Iridium to any person, entity, project, use, or country in violation of the laws or licensing requirements of the United States or any other appropriate national authority.

The officer or employee named below has the knowledge and authority to make the statements made herein on behalf of Company.

If any of the information provided, including but not limited to the Board of Directors and Senior Management, should change after the date of this certification, you are required to promptly notify Iridium in writing of said changes at the contact number below.

This Export Compliance Certification is executed on behalf of (company):*

Officer or Employee Name*

First Last

Officer or Employee Title:*

Officer or Employee Email*

Officer or Employee Phone*

This field is hidden when viewing the form

DynamicsID*

This field is hidden when viewing the form

RequestID*

Comments

This field is for validation purposes and should be left unchanged.

Company Administration Information

ORDER PLACEMENT AND SHIPPING CONTACT

SERVICE DESKPlease specify the individual in your company you would like to have access to submit technical tickets during development. This individual will receive access to the Service Desk.

INVOICING AND BILLING CONTACTS

AIRTIME PROVISIONING

IRIDIUM FOR PARTNERS (IFP) SUPER ADMIN CONTACT

IRIDIUM FOR PARTNERS (IFP) MARKETING CONTACT

EXPORT COMPLIANCE CERTIFICATION

SERVICE DESK