1. Date of Agreement Account Number ___________________
By signing this Agreement for Cincinnati Bell Wireless equipment and service, I agree to the following terms & conditions for
each mobile phone number listed on this document.
Agreement Term:
 24 months from the date of this Agreement (“Term”)
 After the initial Term, the Agreement will renew automatically on a month-to-month basis.
Agreement Types (Agreement Type must be selected for each mobile listed below):
Premium Tier -- applies to purchases of Smart Devices that also require a subscription to a qualifying data plan
Standard Tier – applies to purchases of feature phones and non-Premium Tier devices
Early Termination Fee:
 After thirty (30) days from date of Agreement, an early termination fee of $325.00 per mobile phone number assigned to
a Premium Tier device and $175 per mobile number assigned to a non-Premium Tier device will apply if service is
cancelled for any reason prior to the end of the Agreement Term. The early termination fee will be prorated by $10.00
per month during the agreement term but will never be less than $50.00.
 After thirty (30) days from date of Agreement, an early termination fee of $75.00 per mobile phone number assigned to a
Premium Tier device will apply if the required data service subscription is cancelled for any reason prior to the end of the
Agreement Term but customer continues to subscribe to voice service. The $75.00 fee for service downgrade does not
affect or lessen the $325.00 early termination fee if service is completely disconnected thereafter.
Terms and Conditions:
 I agree to the General Terms and Conditions for Wireless Service (version 11-10) set forth in the CBW Welcome Guide,
or otherwise provided to me by or on behalf of Cincinnati Bell Wireless. The General Terms and Conditions for Wireless
Service are part of my Agreement with Cincinnati Bell Wireless, and contain important information regarding billing, late
payment fees, limitations of liability, settlement of disputes by arbitration, availability/interruption of wireless service, and
other provisions affecting my rights and remedies.
 By signing this Agreement, I revoke any prior out-of-warranty equipment replacement pricing policies that may apply,
including, but not limited to, Lifetime Replacement Program. Equipment upgrades during the Term of Agreement will not
be discounted.
Credit Reporting:
 I authorize Cincinnati Bell Wireless to investigate my credit history at any time and to share credit information about me
with credit reporting agencies.
The Agreement for Cincinnati Bell Wireless services consists of this cover page, the General Terms and Conditions for Wireless
Service (version 11-10), a description of equipment, calling plans, and other service information.
I acknowledge receipt and agreement to the General Terms and Conditions for Wireless Service (version 11-10):
Account Name: Cincinnati Bell Wireless LLC
Signature: Signature:
Printed Name: Printed Name:
Title: Title:
Date: Date:
Mobile Number Agreement Number** Model Price Agreement Type (Check One)
□ Premium Tier □ Standard Tier
□ Premium Tier □ Standard Tier
□ Premium Tier □ Standard Tier
□ Premium Tier □ Standard Tier
□ Premium Tier □ Standard Tier
**COCA will assign Agreement Numbers when contract information is entered. All manual contracts
must be entered in COCA. Agreement Numbers may be generated by COCA upon request prior to
filling out manual contract.