Wireless Order Form

Rise Tech (866) 228-8669

Your Rep: Ashley Klass

Customer Information

First Name required
Last Name Required
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Must Be In Format XXX-XX-XXXX
Address Required
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Must be 5 digit zip

Customer Contact Info

Must be a 10 digit phone number XXX-XXX-XXXX
Must be a valid 10 digit phone number XXX-XXX-XXXX
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Must be a valid date MM/DD/YYYY
Must be a valid email address
Can not be blank
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Exclusive benefits for AT&T Unlimited &More:
  • Unlimited Text, Talk & Data SD Streaming
  • 30+ channels live & On Demand with the WatchTV app
  • 4G LTE speed
  • Unlimited calls to/roaming in Mexico/Canada
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Exclusive benefits for AT&T Unlimited &More Premium:
  • Stream Entertainment in HD
    Plan includes Stream Saver. Toggle Stream Saver off to stream video in HD quality, when available.
  • 15GB Mobile Hotspot
    After 15GB, hotspot speed limited to max of 128Kbps.
  • Choose one of seven music, movie, or entertainment perks: HBO, Cinemax, Showtime, STARZ, VRV, Amazon Music Unlimited, or Pandora Premium.
Enroll in autopay for an additional $10/mo discount

If Porting From Other Carrier

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Numbers To Port: (click + for additional numbers)
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**Please note, to complete your order you will be required to pay 10% sales tax on the devices. **

Please double check all information provided is correct to avoid processing delays. After your order is submitted, please be ready for a call from our call center to confirm your order and receive your install date and time.

To the best of your knowledge, you do NOT have a past due bill with AT&T wireless, U-verse or Directv. If you do, you will NOT qualify for service. With permission, you may complete this form with a friend or family members information.


I understand with the submission of this order form I am agreeing to sign up for services. I understand my personal information will not be saved nor shared. All personal information will be used solely to process this order for service. If you agree to the above statement, please sign your name below.