iPhone Order – Harvest Forms

iPhone Order Form

Model	Price	Storage	Color Options
iPhone XR	$ 49.99	64GB	Blue, Red, White, Black, Yellow, Coral
iPhone XR	$ 99.99	128GB	Blue, Red, White, Black, Yellow, Coral
iPhone 11	$ 149.99	64GB	Red, Black, Purple, Yellow, Green, White
iPhone 11	$ 199.99	128GB	Red, Black, Purple, Yellow, Green, White
iPhone 11	$ 299.99	256GB	Red, Black, Purple, Yellow, Green, White
iPhone 11 PRO	$ 549.99	64GB	Silver, Space Gray
iPhone 11 PRO	$ 699.99	256GB	Silver, Space Gray
iPhone 11 PRO MAX	$ 649.99	64GB	Midnight Green, Space Gray, Gold
iPhone 11 PRO MAX	$ 799.99	256GB	Midnight Green, Space Gray, Gold
iPhone SE (2020)	$ 0.99	64GB	White, Black, Red
iPhone SE (2020)	$ 49.99	128GB	White, Black, Red
iPhone SE (2020)	$ 99.99	256GB	White, Black, Red
iPhone 12 mini	$ 249.99	64GB	Blue, White, Black, Green, Red
iPhone 12 mini	$ 299.99	128GB	Blue, White, Black, Green, Red
iPhone 12 mini	$ 399.99	256GB	Blue, White, Black, Green, Red
iPhone 12	$ 49.99	64GB	White, Black, Blue, Red, Green
iPhone 12	$ 399.99	128GB	White, Black, Blue, Red, Green
iPhone 12	$ 499.99	256GB	White, Black, Blue, Red, Green
iPhone 12 Pro	$ 549.99	128GB	Pacific Blue, Graphite, Gold, Silver
iPhone 12 Pro	$ 649.99	256GB	Pacific Blue, Graphite, Gold, Silver
iPhone 12 Pro	$ 849.99	512GB	Pacific Blue, Graphite, Gold, Silver
iPhone 12 Pro Max	$ 649.99	128GB	Graphite, Gold, Silver, Pacific Blue
iPhone 12 Pro Max	$ 749.99	256GB	Graphite, Gold, Silver, Pacific Blue
iPhone 12 Pro Max	$ 949.99	512GB	Graphite, Gold, Silver, Pacific Blue

iPhone Order Form

New Phone Information

Name

First

Last

Cell Phone Number

Model

Storage

iPhone XR

Color

iPhone XR

Storage

iPhone 11

Color

iPhone 11

Storage

iPhone 11 PRO

Color

iPhone 11 PRO

Storage

iPhone 11 PRO MAX

Color

iPhone 11 PRO MAX

Storage

iPhone SE (2020)

Color

iPhone SE (2020)

Storage

iPhone 12 mini

Color

iPhone 12 mini

Storage

iPhone 12

Color

iPhone 12

Storage

iPhone 12 Pro

Color

iPhone 12 Pro

Storage

iPhone 12 Pro Max

Color

iPhone 12 Pro Max

Add a 20W USB-C Power Adapter?

Yes - $14.98

No - $0

TRANSFERRING SERVICE FROM A PERSONAL CARRIER TO THE HARVEST PLAN

Yes

(Only some approved staff positions have this benefit)

Previous Carrier Information:

Account Number

Account PIN

Authorized Signer Name

Device ID

Find your iPhone serial number, IMEI, ICCID or MEID in the About Screen on your device.

Billing Address

City

State/Province

Zip/Postal

Call your carrier to release your number:

You must call your carrier and authorize the porting/ releasing of your phone number to Harvest Bible Chapel.
If asked, tell them: Manager name: Philip Mathew - pmathew@harvestbiblechapel.org Phone: 847-456-0802

I acknowledge that my phone is paid off, and the carrier has unlocked the phone.

Yes

I have called my carrier to release /port my phone number.

Yes

Signature

Clear

I consent to the phone price being deducted from my paycheck following receipt of my phone
Note: The phone must remain active with Verizon for 90 days before it becomes unlocked.

If you are human, leave this field blank.

iPhone Order Form

New Phone Information

Previous Carrier Information:

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