CCNA

PON

ICSC

ASC-EC

LAST SAVED

BAT 

1VZON 

NY01 

1/4/2007 8:54 am 

VER

STATUS

D/T SENT

1 

DRAFT 

STATE

D/T UPDATED

REQTYP

ACT

ACTI

RTR

EXP

SUP

SD 

N 

S 

UNIT

QTY

QTY

NOR

QSA

TQ

AFO

C 

1 

 of  

01 

DDD

CBD

PPTD

PFPTD

FDT

12 - 30 - 08 

 -  -  

 -  -  

  :   

CKR

ABCD100000ABC 

ECCKT

FNI

FNT

RFNI

CFNI

N12345 

A 

ACTL

PBT

AI

APOT

LATA

LA

LANM

LADATED

ABCDNYXXW01 

C 

ABCDNYXXK01 

 -  -  

LTP

ASG

TSC

CC

UNE

BSA

PSL

PSLI

WST

ISTN

 123

 -  -  

PIU

PLU

LUP

BAN

CUST

FBA

EF

DT

MUX

100 

111 A11 - 1111 

SPEC

PROJECT

CNO

QA

AENG

ALBR

AGAUTH

DATED

 -  -  

BIC

BIC TEL

BIC ID

TSP

SAN

AFG

 -  -  

 -  

RORD

RPON

CCVN

BILLNM

SBILLNM

ACNA

TE

EBP

COMPANY BILLING NAME 

DEPARTMENT FOR BILLING 

BAT 

STREET

FLOOR

ROOM

CITY

STATE

ZIP CODE

WHERE BILL IS TO BE SENT 

ANYWHERE 

TX 

12345 -  

BILLCON

BILLCON EMAIL

TEL NO

ACCT PAYABLE 

999 - 999 - 9999 -  

VTA

VCVTA

IWBAN

60 

 -  -   

PNUM

PSD

FB12345 

 -  -   

INIT

TEL NO

INIT FAX NO

JOHN DOE 

999 - 999 - 9999 -  

 -  -  

INIT EMAIL

JJOHN.DOE@YOURCOMPANY.COM 

STREET

FLOOR

ROOM

CITY

STATE

ZIP CODE

DSGCON

TEL NO

DSG FAX NO

DRC

FDRC

JANE DOE 

999 - 999 - 9999 -  

999 - 999 - 9999 

DSG EMAIL

JANE.DOE@YOURCOMPANY.COM  

STREET

FLOOR

ROOM

CITY

STATE

ZIP CODE

10 MAIN ST 

ANYWHERE 

TX 

12345 -  

IMPCON

TEL NO

MTCE

TEL NO

DUTY TECH 

999 - 999 - 9999 -  

 -  -  

VZON - ESTABLISH 100MB WITH 50 THROUGHPUT ETHERNET EPL TO MY 

NETWORK AT 10 MAIN ST. NEW YORK, NY 11111 CASE # 111111 

WHEN THIS PRODUCT IS ORDERED UNDER A PRIVATE CARRIAGE AGREEMENT (FORBEARANCE),

THE CONTRACT ID MUST BE POPULATED IN THE PNUM FIELD ON THE ASR FORM.

CCNA

PON

ICSC

ASC-EC

LAST SAVED

BAT 

1VZON 

NY01 

1/4/2007 8:54 am 

VER

STATUS

D/T SENT

1 

DRAFT 

STATE

D/T UPDATED

NC

NCI

SECNCI

PQPR

QPR

KQPC 

04ST6 . A .  

04LN9 . 1CT .  .  .  

TLV

SECTLV

  .  T   .  R 

  .  T   .  R

NSL

CKLT

MST

NVC

CLK

PSPEED

LMP

N/U

ZLG

BSC

ETET

MUXLOC

SSS

ATN

XXXXNYXXXXX

SR

ISDN SEQ

TRF

HVP

NSIM

 of  

WACD1

WACD2

CTX TEL

CTX LSTD NM

 -  -  

CFAU

DES

TYPE

CHAN

A LOCATION

Z LOCATION

CFA:  

 ABCDE

/

 OC03

/

 1

/

 ABCDNYXXW01

/

 XXXXNYXXXXX

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

CCNA

PON

ICSC

ASC-EC

LAST SAVED

BAT 

1VZON 

NY01 

1/4/2007 8:54 am 

VER

STATUS

D/T SENT

1 

DRAFT 

STATE

D/T UPDATED

REF NUM

PI

AFT

0001 

EUNAME

NCON

ENDUSER 

SAPR

SANO

SASF

12345 

SASD

RR

ROUTE#

STREET NAME

SATH

SASS

 NW

SOMEWHERE 

ST 

LD1

LV1

LD2

LV2

LD3

LV3

CITY

STATE

ZIP

ANYTOWN 

NY 

12345 -  

ADDITIONAL ADDRESS INFORMATION

JS

JK CODE

SMJK

JK NUM

JK POS

PCA

REN

D 

SI

SPOT

ICOL

LCON

ACTEL

AACTEL

ACPGN

ACPPN

BRANDON DOE  

999 - 999 - 9999 -  

 -  -  -  

 -  -  

ALCON

ALCON TEL

 -  -  -  

ACCESS INFORMATION

WKTEL

 -  -