77010 11134 Aggregated Telecommunications Services - Order ... · Group 77010 Page 14 Award 11134 Aggregated Telecommunications Services Remarks . Group 77010 Page 15 ... CKL EQ Circuit

Group 77010 Page 1 Award 11134 Aggregated Telecommunications Services

ORDER FORMS

ORDER FORMS............................................................................................................... 1 AT&T ORDER FORMS ................................................................................................ 2 MCI WORLDCOM ORDER FORMS ......................................................................... 21 VERIZON ORDER FORMS........................................................................................ 33


AT&T ORDER FORMS


A T & T NODAL SERVICES DEDICATED (T1.5) ACCESS REQUIRED SERVICE REQUEST INFORMATION

COMPANY NAME: _____________________________________________________________ MASTER COMPANY NUMBER (MCN): ____________________________________________ OneNet Account Number: _________________________________________________________ CUSTOMER LOCATION ID (CLID): ________________________________________________ SALES POSITION ID (SPID): ______________________________________________________ SERVICE LOCATION INFORMATION

NEW ( ) EXISTING ( ) LOCATION NAME: _____________________________________________________________________

STREET ADDRESS: ______________________________________________________________________

FLOOR AND ROOM NUMBER: ____________________________________________________________

CITY, STATE , ZIP CODE: ________________________________________________________________

COUNTY: ________________________________________ LSO: _______________________________

LOCAL CUSTOMER CONTACT: ___________________________________________________________

LOCAL CUSTOMER TELEPHONE #________________________________________________________

LOCAL CUSTOMER E-MAIL ADDRESS: ____________________________________________________

LOCAL CUSTOMER PAGER NUMBER _____________________________________________________ BILLING INFORMATION

(IF DIFFERENT THAN SVC. INFO.)

BILLING NAME:

STREET ADDRESS:

FLOOR AND ROOM NUMBER:

CITY, STATE , ZIP CODE:

BILLING CUSTOMER CONTACT:

BILLING CUSTOMER TELEPHONE #

BILL GROUP CODE(GRC): BILLING TEL.# (BTN):

PROMOTION CODE: PLAN ID (PLID):

HOT SPOT AUTHORIZATION CODE:



LOCATION EQUIPMENT INFORMATION

PBX (MAKE & MODEL #):

PBX VENDOR TECH. NAME:

PBX VENDOR TECH. TEL.#: CSU (MAKE & MODEL #):

CSU VENDOR TECH. NAME :

CSU VENDOR TECH. TEL.#: MUX / D4 CHANNEL BANK: JACK TYPE: M24 (Y / N) :

IF CENTREX LOCATION PROVIDE

LOCAL EXCHANGE CO. (LEC) NAME:

CENTREX ADDRESS:

CITY, STATE, ZIP:

LEC CONTACT NAME & TEL. #:

CENTREX CONTACT NAME & TEL. #:

NODAL SIGNAL REQUIREMENTS

FRAMIING FORMAT: ( ) D4 ( ) ESF

LINE CODING: ( ) AMI ( ) B8ZS

*** ISDN D-Channel Inverted ( ) ISDN D-Channel Non-Inverted (x )

OUTBOUND SIGNALING: ( ) DTMFWK ( ) MFWINK ( ) DPIMMEDIATE

INBOUND SIGNALING: ( ) DTMFWK ( ) SEIZURE / IMMEDIATE ( ) WINK



SCOPE OF THIS REQUEST

CUSTOMER PURCHASE DECISION DATE:

CUSTOMER REQUESTED DUE DATE: SERVICE REQUEST ACTION: ( ) NEW ( ) CHANGE ( ) DELETE

*** If inside move (same service address, different location), please provide existing and new location (from-to): ________________________________________________________________________________________________

ACCESS TYPE

( ) TOTAL SERVICE | ( ) BASELINE SERVICE* | ( ) COORDINATED SERVICE*

( ) SERVICE TO SERVICE INTERCONNECT* | ( ) T45 (provide ckt. id & mpc's)

( ) OTHER *TIE DOWN INFO: ALTERNATE ACCESS VENDOR (AAV) NAME & LSO: SAFER / DIVERSITY arrangement? ( Y / N):

**If yes please specify: ACCESS PLAN: ( ) AVA ( ) AVP ( ) OTHER – Will DATA SERVICES terminate on this requested access? (Yes / No): .

If yes, describe –


A T & T NODAL SERVICES DEDICATED (T1.5) ACCESS

REQUIRED SERVICE REQUEST INFORMATION NODAL INBOUND SERVICES MEGACOM 800 ( Yes / No): account # if existing:

Primary 800 Number(s):

Secondary 800 Number(s):

Number of Digits Out Pulsed:

DNIS Digits: MULTIQUEST (Yes / No): account # if




DNIS Digits:

TOLL-FREE MULTI-MEDIA (Yes / No):




DNIS Digits VOICE:

DNIS Digits DATA:

MEGACOM OUTBOUND (Yes / No): account # if existing:

Number of RTN's:

Specific RTN's (if existing)

UNIPLAN / MEGACOM Plus ( ) account # if existing: In-Bound Call Handling Capabilities

( ) Intrastate ( ) Interstate ( ) International ( ) Mexico / Canada Overflow (Yes / No) If yes, provide POTS #:

Shared Access for Switched Svcs. SASS (Yes / No):

If yes, list Nodal Svcs. and describe in remarks.

Advanced Features (Yes / No): If yes, provide details in remarks with routing plan.



NODAL OUTBOUND SERVICES

SERVICE TYPE: ( ) SDN ( ) SDDN ( ) SDN-SASS ( ) One-NET

Local Serving Office {LSO = NPA-NXX}:

Lead Dial Number (LDN):

DIALING PLAN: ( ) 7 digits dialed ( ) 10 digits dialed ( ) both

List Applicable Dialing Plan Station Ranges (DID and / or NON-DID):

Trunk Group Operation: ( ) One-Way Out ( ) One-Way In ( ) Two-Way SDN FEATURES : ( ) ADD ( ) DELETE ( ) CHANGE Off-Net Overflow ( ) Provide POTS # - _______________________________________

Network Remote Access (NRA) Express ( ) Provide 800 # and POTS # :

(8 ) & ( )

Software Defined Data Network (SDDN 56/64K) ( ) {Static ( ) or Dynamic ( )}

SDDN 336K Service ( )

SDDN 700 # In-Dialing ( )

Select Key Service Protection (SKSP) ( )

SDN Static Integrated Network Access (SINA) with M24 ( )

SDN Static Integrated Network Access (SINA) without M24 ( )

Split Access & Flexible Egress Routing (SAFER) ( )

*Provide SAFER / Diversity Approval Number :

Primary Network Interface (PNI) ( )

In-Band Automatic Number Identification (ANI) ( )

If SDN SINA or SASS is being used, indicate the other service(s) which are involved:

Please list and describe other SDN features to be included with this request:


A T & T SERVICE SPECIFIC INFORMATION

Intergrated Services Digital Network ISDN SERVICES

Please indicate the subscribed service supported by ISDN D- Channel, If In-bound and / or Out-bound, complete the appropriate page(s) of this document. SDN ( ) SDDN 56/64/336 ( x ) MEGACOM ( ) MEG8 ( ) MULTIQUEST ( )

TOLL-FREE MULTIMEDIA 800 ( ) Switched Digital Svc. 56/64R ( )

Switched Digital Svc. 64/384C ( ) Switched Digital Svc. 700 # In-Dial ( )

OTHER ISDN Sub Svc. ( ) describe – Notes:

B & D CHANNEL INFORMATION

Number of B-Channels :

Number of Primary D-Channels :

Number of Back-Up D-Channels:

D-Channel(s) with Temporary Signaling Connections (TCS) ( Yes / No):

Identify D-Channel(s) to have TSC :

Is Equipment NFAS Capable ? (Yes / No): M24 (SINA 3) (Yes / No):

Date when Premise Equipment ready for testing: ISDN LOCATION INFORMATION IF EXISTING

Customer Location CLLI:

AT&T Service Node CLLI: ISDN FEATURES

Please provide an ANI SID Option Preferred (ASOP) - ISDN Features for each Trunk Group (ANI, PAN, SID, PSI, REQ or NAS):

Trunk Subgroup Overflow (Yes / No): If yes, provide from what TGP to what TGP & if overflowing to existing NON ISDN Trunk Group:


800 Inbound Order Form RDS Inbound Services _____________________________________________________________________________ MDS Rec'd Date:__________________________________ Location Name:__________________________________ RDS Sent Date: __________________________________________________________________________________ Please provide the Toll Free account number (186 or 146) if existing, or "New":_______________________________ Usage Billing Will Usage bill to the same bill group as listed on the MDS?:______________________________________________ Is this an existing bill group?:______________GRC for Channels:__________________________________________ Will Usage bill to the same bill address?: ________________________________________ Usage Mailing Address: Company Name:________________________________________________________________________________ Address:_______________________________________________________________________________________ City:__________________________________________State:________________Zip:________________________


Call Detail

Billing

Is Call Detail

required?:

Will Call Detail bill to the

same address?:

Call Detail Mailing

Address:

Company

Name:

Address:

City:

State:

Zip:

Executive Summary

Address

Is an Executive Summary

required?:

Media

Type:

Will Executive Summary bill to the

same address?:

Executive Summary

Mailing Address:

Company

Name:

Address:

City:

State:

Zip:


Existing Toll

Free Number

Does the Toll Free Number exist on

another AT&T service?:

If yes, please provide the current

account number, if known:

Listing Name:

Listing

Address:

Listing City:

State:

Zip:

OCDD/RT: OCDD/NT account

number (144), or "New":

Overflow to

ReadyLine:

Toll Free Number:

Inband ANI: Trunk Sub-Group

Overflow:

AT&T Toll

Free Direct:

Receive calls from:

Will any Toll Free Numbers be

ported from another carrier?:

List Toll Free

Numbers:


How many digits will your equipment be

expecting from AT&T (limit 10)?:

If the DNIS digit is over 4 digits then what

number should be used as a Prefix?:


Toll Free#

information

NAR Form Toll Free# or

New PRI or SEC Activity

Type Call Cap Payphone

blocking RRN DNIS Signaling

Inbound Inter -

National Publish

ed SIS/Term RA CDG

If 800 is to be listed place address

information here:


Remarks


ISDN TOLL FREE MULTIMEDIA

SERVICE SECTION

What is the Primary Toll

Free Number?:

Number of digits to be

outpulsed:

Specific DNIS digits

outpulsed for Voice:

Specific DNIS digits

outpulsed for Data:

Remarks

Group 77010 Page 16 Award 11134 Aggregated Telecommunications Services Outbound Long Distance Switched Order Form and COVER PAGE

AT&T Local Line (Switched Access) Request for New York OGS

FAX COMPLETED REQUEST TO 800-738-2605 Requested By: ____________________________________________________________ Phone: (__________)______________________ Date: ___________________________ Add Brand New Location _____________ Delete Telephone Number(s) _______ Add Telephone Number(s) to Existing Delete Entire Location(s) __________ Location ______ Other: _________________________________________________________________ Billing Name: ______________________________________________________________ Billing Address: ____________________________________________________________ City, State, Zip: ____________________________________________________________ (Complete the following ONLY if different from billing information) Service Name: _____________________________________________________________ Service Address: ___________________________________________________________ City, State, Zip: ____________________________________________________________ Customer Contact: _____________________________ Phone: ______________________ Bill Group/GRC (if known): __________________________________________________ MAIN Telephone Number for this Billing Location: _________________________ Customer Code: _____________ Due Date: (Fill In One) Customer to PIC lines: _________ AT&T to PIC lines: ___________ *Line number(s): (If new location, include MAIN telephone #)

*Please indicate if any additional lines are billed by local phone company as main billed numbers

PLEASE FAX COMPLETED FORM AND COVER PAGE TO 800 738-2605


Local Services Prime Order Form:

Customer Information

Company Name

Contract Term

Service Address

Contract Sign Date

Suite / Room Business Hours Floor Requested Due

Date

City, State Interval Time frame Days Zip Who extends

Demarc select one

Demarc Loc. Billing Information (if different from above) Billing Name BAN Attention Billing Contact Billing Address Contact Phone Suite/Room-Floor

Tax Exempt Yes No

City, State Local Call Detail select one Zip Billing Remittance select one Contact Information Customer Name

Phone No.(s)

Email address

Onsite LCON Phone No.(s)

Email address

Technical Name

Phone No.(s)

Email address

Vendor Contact Phone No.(s)

Email address

Account Team Information

Minimum Quality Data SetAT&T Local Service

Group 77010 Page 18 Award 11134 Aggregated Telecommunications Services Sales Executive

Phone No.(s)

Email address

Local Specialist Phone No.(s)

Email address

Sales Manager Phone No.(s)

Email address

Bundled Billing Information ABN Account Yes No Lead Acct (171) Sub Acct (124) OneNet Account Yes No OneNet Sub Account MCN CKL EQ Circuit ID (PWOT only) Prime Standalone Contract Term, PIC Information and LEC Information

Prime Term: 1yr 2yr 3yr

GCT Code Approving Manager

GCT Level A B C D E Approving Mgr Number NSR Authorization Code

Reason

IntraLATA PIC* select one

Other: InterLATA PIC * select one Other:

ALS CLLI LEC CLLI Access Type I II Porting? Yes No Current LEC

Current LEC MBTN

LOA Signed Date

* AT&T LD Plan required if IntraLATA/InterLATA is PIC’d to AT&T (Please enter LD Plan into comments section) Prime Standalone Calling Plan (Note: USOC information is located on page 3 of this form)

Local / PrimeOne (Zone1) Yes No MOU Rate

Rate Table $ Discount

Local / PrimeOne (Zone 2) Yes No MOU Rate

Rate Table $ Discount

Local / PrimeOne (Zone 3) Yes No MOU Rate Rate Table $ Discount IntraLATA Toll/Prime Plus Yes No

MOU Rate Rate Table $ Discount

Project Scope (Mandatory) and Special Instructions (Optional): SDM to Complete CPE CPE Manufacturer (all Services): Model: T1 Configurations For PrimeXpress / ABN-Local DS-1 / Prime Digital Trunk / DS-1 Digital Facilities Customer Type select one Existing Trunk Group Yes No Channel Type select one Channel Range Pulse Type select one Coding select one Digits Out to CPE Framing select one Signaling Instart select one DS1 Termination select one Signaling Outstart select one Hunting Sequence select one

Group 77010 Page 19 Award 11134 Aggregated Telecommunications Services Supervision select one Inbound Blocking

Packages select one

Outbound Blocking Packages

select one Existing TG Number?

T1 Configurations For PrimePlex / PrimeConnect / ABN- Local PRI / ISDN-PRI %Data %Voice Customer Type select one Existing Trunk Group Yes No Channel Type select one Channel Range Application select one Arrangement select one Service Type select one D Channel Configuration select one ISDN Version select one Hunting Sequence select one Pulse Type select one DS1 Termination select one Outbound Blocking Packages

select one Inbound Blocking Packages

select one

Digits Out to CPE Existing TG Number? Configuration for PrimePath* / ABN Lines & Trunks* / PrimePath NBX * Existing Trunk Group Yes No If yes,

TGN?

Analog Business Lines (POTS)

PrimePath Basic Line Quantity

Analog Key Line PrimePath Key Line (Loop Start) Quantity Analog Key Line PrimePath Key Line (Ground

Start) Quantity

Analog Business Trunk PrimePath (DOD) Trunk Quantity Analog Business Trunk PrimePath 2 Way Combo Trunk Quantity Analog Business Trunk PrimePath Inbound Trunk Quantity Analog PBX (DID) Trunk PrimePath (DID) Trunk Quantity

Digits out to CPE

Signaling DID Trunk select one Pulse Type select one

Outbound Blocking Packages select one Inbound Blocking Packages

select one

* Must Also Complete a Line Feature Form http://local.kweb.att.com/all/provisioning/PrimePath_Features.xls Comments and/or Special Instructions:

Group 77010 Page 20 Award 11134 Aggregated Telecommunications Services AE to Complete USOC Information USOC Service Type QTY Unit MRC Unit NRC TOTAL New LNS Telephone Number Assignment & Directory Listing Information New LNS TNs to Add? Yes No If yes, see attached email from the TN Assignment Group Quantity New LNS MBTN? Is Directory listing new or changing?

Yes No Select Listing Type select one

Is the Listed TN? ALS LNP

Which Directory? select one

TN to be listed in DL?

Yellow Page Heading

Porting Information

Porting entire account? Yes No Is Customer Moving? Yes No Porting LEC BTN? Yes No New LEC BTN, if LEC BTN is being ported Total Quantity of Ported Numbers

LEC BTN: From: To: Port (Only) LEC BTN From: To: Port (Only)


MCI WORLDCOM ORDER FORMS


MCI WorldCom Service Inquiry Form Organization:

Primary Contact Name: Title:

Phone Number: Fax Number:

Email Address: Service Type Requested: Please indicate by marking next to all applications requested.

! Outbound Voice Services (Complete Section A) ! Inbound Tollfree Services (Complete Section B) ! Conferencing (Complete Section C) ! Local (Complete Section D) ! Other; Please provide details:

______________________________________________________________________________________________________________________ ___________________________________________________________

Billing Address Information

Billing Name Street Address

City, State, Zip Code Billing Contact Name

Contact Phone Number

Section A Outbound Voice Services ! Yes ! No Does your organization have multiple locations? ! Yes ! No Do any of your locations require Dedicated (T1) access? ! Yes ! No Is your organization utilizing accounting or security codes?

Section B Inbound Tol l f ree Services ! Yes ! No Is your organization currently using tollfree numbers? ! Yes ! No Are you migrating or porting an existing tollfree number(s) to WorldCom? ! Yes ! No Do you require Dedicated (T1) access?

Section C Confererencing ! Yes ! No Is your organization currently utilizing audioconferencing? ! Yes ! No Does your organization have videoconferencing capabilities? ! Yes ! No Has your organizaiton provided remote training or instruction?

Section D Local ! Yes ! No Are you interested in local services at a new location? ! Yes ! No Do you currently utilize dedicated (T1) local services? Comments:

MCI WorldCom Local Sales Order Form Customer Addresses

Group 77010 Page 23 Award 11134 Aggregated Telecommunications Services Service Location (Dmarc

Location) Billing Address

Company Name

Attn: Street Floor/Suite # City County Not Required State Zip Customer Contacts Local Contact CPE Vendor Directory Info Company Name

Contact Name Phone # Pager # Type of Business

Not Required Not Required

Basic Service Order Information Service Type Quan-

tity? On-Ring or

Local Direct? Analog or Digital?

New or LNP

Signaling Framing/ Coding

2-Way Trunk DID Trunk ISDN / PRI 1-Way In Trunk

1-Way Out Trunk

Local Line Co-Lo Line Number Reservation Information Quantity of numbers required: Numbering restrictions or specific range requirements: CPE Information Customer Premises Equipment (PBX, Key System): • Model Name: • Model Number: • Software Version: • Other CPE requirements: Customer or MCIW provided Equipment?

Group 77010 Page 24 Award 11134 Aggregated Telecommunications Services Service Description / Other Comments General description of service and any/all unique requirements should be defined here: ________________________________________________________________

Group 77010 Page 25 Award 11134 Aggregated Telecommunications Services Toll Free Dedicated Order Form

Customer Name: Requested Due Date:

CUSTOMER BILLING INFORMATION

Billing Name:

Billing Address: Suite or Room #:

City: State: Zip:

Billing Contact: Contact Phone:

Billing ID: ! New ! Existing If Existing, specify ID:

ACCESS LOCATION INFORMATION

Local Customer Name:

Address: Main Listed Phone:

City: State: Zip:

Local Contact: Local Contact Phone:

Alternate Contact: Alternate Contact Phone:

Demarc Location � Bldg: Floor: Room:

Extended Demarc � Bldg: Floor: Room:

HARDWIRE INFORMATION *Multiple columns only to be used for multiple trunk groups on the same T-1.

Trunk Group: 1 2 3 4 5 6

Toll Free Number:

Billing ID:

Number of Circuits:

T-1 Chnl Assignment:

Signaling:

Applicable Signaling Types: E&M 1, E&M 2, E&M 3, Wink, Immediate, GroundStart, LoopStart ACCESS INFORMATION Access Type: ! 2-Wire Loop ! 4-Wire Loop ! New T-1 ! Existing T-1 (Specify) Circuits Ordered By: ! MCI ! Customer ! Co-Location (None) Choose One: # Interstate # Intrastate Alternate LEC: ! Yes ! No Alternate LEC (if necessary):

Where available, WorldCom Local or CLEC/CAP facilities will be used. FEATURE INFORMATION Trunk Group: 1 2 3 4 5 6

Outpulse/DNIS length:

RTANI: ! Yes ! No ! Yes ! No ! Yes ! No ! Yes ! No ! Yes ! No ! Yes ! No

Supp Code Length:

! Option 2 ! Option 3

Group 77010 Page 26 Award 11134 Aggregated Telecommunications Services EQUIPMENT INFORMATION

Equipment Requested

Equipment Provider Equipment Maintainer Equipment Owner

CSU ! WorldCom ! Cust ! Third ! WorldCom ! Cust ! Third ! WorldCom ! Cust ! Third DSU ! WorldCom ! Cust ! Third ! WorldCom ! Cust ! Third ! WorldCom ! Cust ! Third CDU ! WorldCom ! Cust ! Third ! WorldCom ! Cust ! Third ! WorldCom ! Cust ! Third

Channel Bank ! WorldCom ! Cust ! Third ! WorldCom ! Cust ! Third ! WorldCom ! Cust ! Third Cards (voice/data) ! WorldCom ! Cust ! Third ! WorldCom ! Cust ! Third ! WorldCom ! Cust ! Third Customer-Provided Equipment:

! ACD ! Centrex ! Keyset ! PBX Feature:

! Analog ! Digital Data Interface Type:

! V.35 ! RS232 ! Other _____________

Framing: ! D4 ! ESF Jack Type: ! RJ11 ! RJ21 ! RJ48 ! Other (specify) _____________ Line Coding: ! AMI ! B8Zs

REMARKS


Toll Free Switched Order Form Are these numbers:

New Install Ported Toll-Free

Toll Free Corp ID (if existing):

Billing ID (if existing):

Customer Name: Main Phone #: Address:

City: State:

Zip:

Primary Contact Name: Title:

Phone #:

BILLING Information Tax Exempt Status: Federal State Local (Exemption form must accompany order)

MAILING ADDRESS FOR BILLING INVOICE Company Name: Address: City: Stat

e: Zip:

Billing Contact: Title:

Phone #:

SERVICE LOCATION INFORMATION Company Name: Termination Address: City: Stat

e: Zip:

Terminating Contact: Title:

Phone #:

TOLL FREE INFORMATION Total #’s Requested:

Customer Requested Date:

Directory Assistance Listing:

Yes No If Directory Assistance Listing, Put On Next Line:

Listing #1: Listing #2:


TOLL FREE DETAIL TOLL FREE NUMBER NEW/PORTED LISTED LEAD ANI (10 DIGIT Telephone

number) 8 - - N P - - 8 - - N P - - 8 - - N P - - 8 - - N P - - 8 - - N P - - 8 - - N P - - 8 - - N P - - 8 - - N P - - 8 - - N P - -

Remarks:


Outbound Long Distance – Dedicated Order Form CUSTOMER BILLING INFORMATION

Billing Name Billing Address

Suite or Room #

City State Zip Billing Contact

Contact Phone Number

Billing ID New Existing If existing, specify ID ACCESS LOCATION INFORMATION

Local Customer Name Netcom Location ID (If existing)

Address Netcom Location ID (If existing)

Main Listed Phone #

City State Zip Local Contact Local Contact Phone # Alternate Contact Alternate Contact Phone # Customer Fax # Vendor Fax # Demarc Location � Bldg

Floor

Room

Extended Demarc � Bldg

Floor

Room

HARDWIRE INFORMATION

(Multiple columns only to be used for multiple trunk groups on the same T1) Trunk Group 1 2 3 4 5 6 Product Type Sub-Service Type Billing ID Number of circuits T-1 Chnl Assignment Signaling Applicable Product Types: Voice Option 2, Voice Option 2 AI, Voice Option 3, Voice Option 3 AI Applicable Signaling Types: E&M 1 E&M 2 E&M 3, Wink, Immediate, GroundStart, LoopStart ACCESS INFORMATION

T-Corp ID* New Existing (Specify) Circuits Ordered By

WCOM Customer Co-Location (None)

Choose One

INTERstate INTRAstate


Alternate LEC

Yes No

Alternate LEC (if necessary)

Where available, WCOM Local or CLEC/CAP facilities will be used. FEATURE INFORMATION

Trunk Group 1 2 3 4 5 6 Outpulse Digit/DNIS Length

RTANI Yes

No

Yes No

Yes No

Yes No

Yes No

Yes No

Hunting Yes

No

Yes No

Yes No

Yes No

Yes No

Yes No

Account Code Length ID Code Set Supp Code Length Range Privilege EQUIPMENT INFORMATION

Equipment Requested

Equipment Provider Equipment Maintainer Equipment Owner

CSU WCOM Cust Third WCOM Cust Third WCOM Cust Third DSU WCOM Cust Third WCOM Cust Third WCOM Cust Third CDU WCOM Cust Third WCOM Cust Third WCOM Cust Third

Channel Bank WCOM Cust Third WCOM Cust Third WCOM Cust Third Cards (Voice /

Data) WCOM Cust Third WCOM Cust Third WCOM Cust Third

Modem WCOM Cust Third WCOM Cust Third WCOM Cust Third Other WCOM Cust Third WCOM Cust Third WCOM Cust Third

Other customer provided equipment: ACD Centrex Keyset

PBX

Feature: Analog Digital

Data Interface Type

V.35 RS232 Other

Framing D4 ESF Jack Type RJ11 RJ21 RJ48 Other

Line Coding AMI B8ZS Vendor Name Phone Number

REMARKS


Outbound Long Distance – Switched Order Form CORPORATE INFORMATION Corporate ID: Billing ID: Customer Name: Main Phone#: Address: City: State: Zip: Contact: Title: Phone#: BILLING OPTIONS Tax exempt Status:

Federal State Local (Exemption form must accompany order)

FEATURE OPTIONS Basic Y N Optional Y N Accounting Codes (Non-Verified) Personal ID Codes (Verified) Switched Digital Service 10-Digit Restriction BRI Access (64Kbps) Custom Range Privilege: Digital Dial (SW56) Access Instant Ringdown

Dialing Plan

SERVICE LOCATION INFORMATION Location Name: Bill Payer ID: Street 1: Contact Name: Street 2: Contact Title: City: Contact Phone Number: State: Zip: Main Listed Phone Number:

DIAL-1 SERVICE INFORMATION Number of lines: MCI PIC LOA LOAM Due Date: PIC Option: InterLATA only IntraLATA only (If available) Both (If available)

ANI DETAIL

ANI’S

Accounting Codes Yes/No Length

ID Codes

Set Length

Range Privilege

For Switched

Data Service ONLY

(Data only) or

(Voice/Data)

Range Privilege

Type Custom or Universal

1 Y N

D V C U

2 Y N

D V C U

Group 77010 Page 32 Award 11134 Aggregated Telecommunications Services 3 Y N

D V C U

4 Y N

D V C U

5 Y N

D V C U

6 Y N

D V C U

7 Y N

D V C U

8 Y N

D V C U

9 Y N

D V C U

10 Y N

D V C U

11 Y N

D V C U

12 Y N

D V C U

CALLING CARD DETAIL CardholderNa

me Package ID*

Promo Code

# of Card

s

# of Code

s

Card #

Pin #

Private Label

Calling Range Privilege

1 Y N 2 Y N 3 Y N 4 Y N 5 Y N 6 Y N Remarks:


VERIZON ORDER FORMS SINGLE POINT OF CONTACT FOR ORDERING, REPAIR AND BILLING: Telephone Number

Fax Email Address Ordering Address

800 441-7406 518 471-2764 [email protected] 11 Wards Lane, Flr 2 Menands, NY 12204

Documents

77010 11134 Aggregated Telecommunications Services - Order ... · Group 77010 Page 14 Award 11134 Aggregated Telecommunications Services Remarks . Group 77010 Page 15 ... CKL EQ Circuit