TRACKING#PREORDER#跟踪#预购.doc

AT&T CENTREX ORDER FORMDSIT SECTIONTRACKING # / PRE ORDER # MAC # REQUESTED DUE DATE DUE DATE SUBMITTED BY DATE SUBMITTED CONTACT # AT&T SECTIONAT&T ORDER # NEW TELEPHONE # DUE DATE NEW CIRCUIT # USOCs Added with MRC & OCC charges USOCs Removed with MRC & OCC charges USOCs Changed with MRC & OCC charges If the data fields are not sufficient in size, attach a copy of the service order to this document. REMOVE ANY ADDITIONAL LISITINGS WHEN DISCONNECTING LINESAGENCY SECTION(Agency Account to be provided by DSIT)BILL TO DSIT ACCOUNT # AGENCY NAME / DIVISION BUILDING NAME BUILDING CODE COST CENTER SVC ADDRESS CITY STATE ZIP CODE CREATED BY & EMAIL RM # PHONE PRIMARY CONTACT RM # PHONE ALT CONTACT RM # PHONE ORDER LINE INFORMATIONTYPE OF ACTIVITY: NEW SERVICE ADD MOVE CHANGE DISCONNECT QUANTITY (CHOOSE ONE)TYPE OF SERVICE: CENTREX ISDN VOICE CIRCUIT 1FB BUSINESS LINE 1FR RESIDENCE LINE (CHOOSE ONE) OTHER EXTENDED / INSIDE WIRING TO RM # OTHER WORKING TELEPHONE NUMBERS AT LOCATION SPECIAL INSTRUCTIONS LOCATION: TO DEMARC ONLY IN EQUIPMENT ROOM JACK TYPE LONG DISTANCE CARRIER: PIC SPIRIT TELECOM 807 LPIC BELLSOUTH 5124 NON- PUBLISHED LISTED RESTRICTIONS 900 & 976 ON 1FB (CREX 4) BCR CALL RETURN COLLECT & 3RD NUMBER BILLING (TBE A) BRD REPEAT DIALING 3RD NUMBER (TBE B)BLKD DIR. ASSIST. CALL COMPLETION COLLECT (TBE C) RCU TWG 3-WAY CALLING UNAUTHORIZED CHARGES (BLOC) DACC ADD ALL BLOCKS AT&T ACCOUNT INFORMATIONDEPARTMENT IDENTIFIER # (if applicable) BILL DIRECT TO AGENCY AT&T BILLING ACCOUNT NUMBER REGIONAL ACCT # NEW BLS BILLING ACCT # AGENCY / DIVISION ADDRESS CITY STATE ZIP CODE ATTENTION CONTACT # SPIRIT ACCOUNT INFORMATIONAGENCY BILLING ACCOUNT # BILL LIKE # FOR STATE AGENCIES ORDERING 1FB LINE, ISDN-BRI SERVICE, PLEASE E-MAIL COMPLETED FORM OR SEND A REGULAR E-MAIL TO SCSG.CSA.. FOR STATE AGENCIES AND NON-STATE ENTITIES ORDERING DSIT CENTREX SERVICE, PLEASE E-MAIL COMPLETED FORM TO: . FOR NON-STATE ENTITIES ORDERING 1FB LINE, ISDN-BRI SERVICE, PLEASE CALL YOUR AT&T REPRESENTATIVE FOR THEIR E-MAIL ADDRESS TOLL FREE AT 1-866-899-1461 OR 1-800-302-6988. REMARKS / COMMENTS / NOTES: SEE BELOWA.M. TO COPY AND PAST