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Iridium Short Term VAD – Set-up Form

Complete this form to establish an equipment account to purchase developer kits and transceivers contained in the VAD Agreement

"*" indicates required fields

Unique ID

Date Submitted*

Company Information

Company Name*

Company Address*

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

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

Ship To Destination same as above?*

Yes

No

Company Name (Ship To Destination)

Ship To Address

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

Orders & Shipping

Contact Name (Order Portal)*

First Last

Title*

Email*

Phone*

Small Package Freight Courier*

Account #*

Method*

Contracted for Equipment Purchase of (mark all that apply):

9602/9603 SBD

9523 LBT

9680 Edge

9690 Edge Pro

9640 Edge Solar

Service Desk

Technical Contact Name*

First Last

Technical Contact Email*

Country of Citizenship*

Invoice & Billing

Contact Name (Invoicing & Billing) #1*

First Last

Title*

Email*

Phone*

Contact Name (Invoicing & Billing) #2*

First Last

Title*

Email*

Phone*

Acknowledgement

Name of Individual Completing Form*

First Last

Email of Individual Completing Form*

Email

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

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