Blink Cell Phone Request Form

Please use this form to request new cell phone service, disconnect, place an accessory order or to make changes to your existing service. Please keep in mind that orders are not processed by the Bookstore but by Blink and most orders take 3-5 business days. For information about how to use this form (858) 246-2366

*Department Name:
*Index Number:
*Mail Code:
*Person Placing Order:
*Area Code & Phone Number:
*Email Address:
*Name of Fiscal Contact:
*Area Code & Phone Number:
*Email Address:
*End User Name:
*Area Code & Phone Number:
*Email Address (UCSD.EDU emails only):
Please check appropriate box
New Service? Desired Area Code for new number:
Upgrade Phone?  
Change rate plan? New rate plan description:
Port Number from one Carrier to another?
Current Carrier:
New Carrier:

Disconnect Service?  

Complete the following fields
Phone/Device Make & Model:
End User Cell Phone Number:
 Voice Plan needed:
Data Plan needed:
Text Messaging Plan needed:
 Accessories needed:
Pick a delivery mode - Choice 1 or 2
 1. Fedex/UPS Shipping Address

 2. No delivery necessary
     Authorization verification rights reserved     
You will receive an e-mail confirmation after your request is successfully submitted.