Items 3 (List) | R&M Variety Shop

First name

Last name

Email/Phone

Do you already have mobile/internet service?

Yes

No

If no, you will have to pay an activation fee of $14.99 (plus tax).

Are you looking to activate mobile/internet service for the first time?

Yes

No

If yes, you will have to pay an activation fee of $14.99 (plus tax).

Select your mobile/internet company

Ultra mobile

H2O

Simple mobile

Lyca mobile

Write down your plan (enter dollar amount with no. of months)

For example: $15.00 for 1 month.

Pick a date and time at our store for your service.

Month

Day

Year

Time

HoursMinutes

MOBILE/INTERNET SERVICE REQUEST