CCNA

PON

ICSC

ASC-EC

LAST SAVED

BAT 

IBT PT 2 PT OB-R 

NE01 

1/8/2007 11:57 am 

STATE

D/T UPDATED

REQTYP

ACT

ACTI

RTR

EXP

SUP

SD 

N 

S 

UNIT

QTY

QTY

NOR

QSA

TQ

AFO

QNAI

EVCI

C 

1 

 of  

01 

DDD

CBD

PPTD

PFPTD

FDT

12 - 30 - 08 

 -  -  

 -  -  

  :   

CKR

ECCKT

FNI

FNT

RFNI

CFNI

ACTL

PBT

AI

APOT

LATA

LA

LANM

LADATED

ABCDMAXAW01 

 -  -  

LTP

ASG

TSC

CC

UNE

BSA

PSL

PSLI

WST

ISTN

 -  -  

PIU

PLU

LUP

BAN

CUST

FBA

EF

DT

MUX

100 

X11 XXX - 1111 

YOUR COMPANY 

SPEC

PROJECT

CNO

QA

AENG

ALBR

AGAUTH

DATED

FB12345

 -  -  

BIC

BIC TEL

BIC ID

TSP

SAN

AFG

 -  -  

 -  

RORD

RPON

CCVN

BILLNM

SBILLNM

ACNA

TE

EBP

COMPANY BILLING NAME 

DEPARTMENT FOR BILLING 

ABC 

STREET

FLOOR

ROOM

CITY

STATE

ZIP CODE

WHERE BILL IS TO BE SENT 

ANYWHERE 

MA 

12345 -  

BILLCON

BILLCON EMAIL

TEL NO

ACCTS PAYABLE 

888 - 888 - 8888 -  

VTA

VCVTA

IWBAN

60 (5 yrs  for North) 

 -  -   

INIT

TEL NO

INIT FAX NO

JOHN/JANE DOE 

888 - 888 - 8888 -  

 -  -  

INIT EMAIL

JOHN/JANE.DOE@YOUR,COMPANY 

STREET

FLOOR

ROOM

CITY

STATE

ZIP CODE

1111 MIAMI BLVD 

ANYWHERE 

MA 

12345 -  

DSGCON

TEL NO

DSG FAX NO

DRC

FDRC

JOHN/JANE DOE 

888 - 888 - 8888 -  

999 - 999 - 9999 

DSG EMAIL

JOHN/JANE.DOE@YOUR,COMPANY 

STREET

FLOOR

ROOM

CITY

STATE

ZIP CODE

1111 MIAMI BLVD 

ANYWHERE 

MA 

12345 -  

IMPCON

TEL NO

MTCE

TEL NO

TECH ON DUTY 

888 - 888 - 8888 -  

 -  -  

PLS INSTALL 1 OC3C.

CCNA

PON

ICSC

ASC-EC

D/T Transmitted

D/T Last Rec

LAST SAVED

BAT 

IBT PT 2 PT OB-R 

NE01 

1/8/2007 11:57 am 

STATE

D/T UPDATED

NC

NCI

SECNCI

PQPR

QPR

OB-R

02SOF . B .  

02SOF . B .  .  .  

TLV

SECTLV

  .  T   .  R 

  .  T   .  R

NSL

CKLT

MST

NVC

CLK

PSPEED

LMP

N/U

ZLG

BSC

ETET

MUXLOC

SSS

ATN

SR

ISDN SEQ

TRF

HVP

NSIM

 of  

WACD1

WACD2

CTX TEL

CTX LSTD NM

 -  -  

CFAU

DES

TYPE

CHAN

A LOCATION

Z LOCATION

CFA:  

/

/

/

/

PRIADM

DIR

CPT

 -  

HBAN

  -  

CCEA

SECLOC

S25

ER

OTC

E  

A 

DES

TYPE

CHAN

A LOCATION

Z LOCATION

SCFA:  

/

/

/

/

SECADM

SDIR

GETO

GBTN

GCON

GTEL

 -  -  

 -  -  -  

SCCEA

SR = BLANK, SINGLE ROUTE. S25 IS BASED ON CORRECT EXEMPTION 

FORMS SUBMITTED. CCEA REQUIRED IF ACTL IS COLOCATED. 

WHEN THIS PRODUCT IS ORDERED  UNDER A PRIVATE CARRIAGE AGREEMENT (FORBEARANCE), THE CONTRACT  ID MUST BE POPULATED IN THE CNO FIELD ON THE ASR FORM.

CCNA

PON

ICSC

ASC-EC

LAST SAVED

BAT 

IBT PT 2 PT OB-R 

NE01 

1/8/2007 11:57 am 

REF NUM

PI

AFT

0001 

C 

EUNAME

NCON

ENDUSER 

SAPR

SANO

SASF

12345 

-----------------------------------------------------------------SASN-----------------------------------------------------------------

SASD

RR

ROUTE#

STREET NAME

SATH

SASS

NW 

SOMEWHERE 

ST 

LD1

LV1

LD2

LV2

LD3

LV3

CITY

STATE

ZIP

ANYWHERE 

MA

98765 -  

ADDITIONAL ADDRESS INFORMATION

JS

JK CODE

SMJK

JK NUM

JK POS

PCA

REN

SI

SPOT

ICOL

C 

ABCDMAXXH31  

LCON

ACTEL

AACTEL

ACPGN

ACPPN

BRANDON DOE 

888 - 888 - 8888 -  

 -  -  -  

 -  -  

ALCON

ALCON TEL

 -  -  -  

ACCESS INFORMATION

WKTEL

 -  -