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M-F 8am-8:30pm CST | Sat 9am-6pm CST | 972-PATRIOT
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CUSTOMER DETAILS
FIRST
NAME
*
LAST
NAME
*
PHONE
NUMBER
*
EMAIL
ADDRESS
*
WHERE DID YOU
HEAR ABOUT US
*
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Account PIN
*
Create a 6-digit PIN for your new Patriot Mobile account.
Who Referred You?
Enter the phone number of the person who referred you.
SHIPPING DETAILS
Same address as Service Address
STREET ADDRESS *
This address needs to match the billing address for the Credit Card that will be used for payment.
UNIT
NUMBER
CITY *
STATE *
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ZIP CODE *
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