Verizon West Pre-Order Connectivity Request Form
Customer Information
Date:05/15/2024
(*) Denotes required field
*Business Name
Contacts
*Primary
*First Name
*Last Name
*E-mail
*Phone Number
for Connectivity
First Name
Last Name
E-mail
Phone Number
for Data Content
First Name
Last Name
E-mail
Phone Number
Software Company/Service Provider Information
*Do you have a Software Company or Service Provider?
Yes No
(*) Denotes required field, if "Yes" is selected in above options.
*Primary
*First Name
*Last Name
*E-mail
*Phone Number
for Connectivity
First Name
Last Name
E-mail
Phone Number
for Data Content
First Name
Last Name
E-mail
Phone Number
*Environment
Please complete and submit two forms, one with your test information and one with your production information even if the information is the same.
CTE
Production
*Customers OCN(s)
 
*Customers CCNA(s)
EDI Sender ID
Qualifier
*What application data will you be transporting?
Order
Pre-Order
Customer Service Inquiry
Loop Qualification
Billing
Usage
*Transport of choice
Connect:Enterprise
HTTPS
FTP Dedicated
Connect:Enterprise
SFTP
Interactive Agent
(I/A)
Connect:Direct
Dedicated (TCP/IP)
CORBA Dedicated (not available for processing LSRs)
Please complete the appropriate section below for the transport of choice you select.
Complete this section if Connect:Enterprise has been checked
(*) Denotes required field if Connect:Enterprise has been checked
How are you submitting today?
*Customers Platform
 
Windows 95/98/NT
UNIX
SFTP only -- Do you have a Secure FTP client (WS/FTP Pro or CUTE FTP)?
Yes
No
If no, you can purchase the product of your choosing, or [SHOW pnCompName] can provide at no cost a Sterling Commerce FTP Client.
HTTPS only - Do you have Internet Explorer 6.0 or Netscape 6.1 or higher?
Yes No
Complete this section if FTP Dedicated, Interactive Agent, Or CORBA has been checked
(*) Denotes required field if FTP Dedicated, Interactive Agent, & CORBA has been checked
*IP Address
*Port
Complete below information, if CORBA has been selected
(*) Denotes required field, if "Yes" is selected in above options.
*VeriSign Root Certificate
*Organization name as it appears on your VeriSign Certificate
Complete this section if Connect:Direct-Dedicated (TCP/IP) has been checked
(*) Denotes required field if Connect:Direct-Dedicated (TCP/IP) has been checked
*Circuit ID
*Circuit Origination
*IP Address
*Port
*Nodename
 
* User ID
*Password
*Customers DATASET name(s)
 

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