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1
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BTN/ACCT #
(Billing Telephone Number/Account number)
(Identify as Res, Bus, or Coin)
(Required Field)
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2
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Billing Name
(Required Field)
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3
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Billing Address
(Required Field)
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4
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Business or Residence Name
(If different than Billing Name)
(Required Field)
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5
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Service Address
(If different than Billing Name)
(Required Field)
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6
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Feature (USOC / English) Description
(Required Field when features exist on account)
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7
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BTN and WTNs (Working Telephone Numbers) with vertical features
(i.e.: Hunting, Custom Calling, Voice Mail, Remote Call Forwarding, etc.)
(Required Field)
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8
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Current PICs (Inter/IntraLATA) including PIC Freeze / Restrictions
(Required Field)
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9
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Options - (i.e.: 900, 700 Blocking, Toll Blocking, etc.)
(Required Field)
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10
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Service Configuration
(i.e., Resale, UNE-P, Loop and Number Portability, Number Portability only,
etc. and Circuit ID(s)/TXNU on a TN by TN basis)
(Required Field)
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11
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Directory Listing Information
(Required Field)
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12
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Line Sharing / Line Splitting (if applicable)
(Required Field)
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(Yes or No)
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13
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Data Information
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