New Cell Modem Activation Form

New Cell Modem Activation Form

This form can be used to request activation for specific cell modems. All requests are processed during normal business hours only. Please allow up to 1 business day after submitting for processing to complete. If you have questions or need follow up, please contact Customer Support via email at support@baselinesystems.com or by phone at 1-866-294-5847.
Please enter your billing information

This form must be filled out separately for each Cell Modem you want to activate.
Account Name *
Country

United States Canada Saudi Arabia
Billing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Authorized Contact Name *

First Name Last Name
Billing Phone Number *

Area Code Phone Number
Billing Fax Number

Area Code Phone Number
Billing Email Address *
Cell Modem SIM Number *
No spaces or dashes. Ex: 89010000000000001834
Cell Modem Serial Number *
Ex: CMX-102999
Controller Name *
Controller Site *
Name of Signee *

First Name Last Name
Signature
Type a question
Additional Notes
Should be Empty: