Administrative Section	PG	OF

SC1	PON*	PRE	cC*

(Note: “PRE” is part of the PON and indicates a pre-order request. Do NOT include the “PRE” in the PON field of the LSR when submitting the firm order request)

TXTYP*	TXact*	tos*	MS*	ATN

NC	NCI

sup

REMARKS

Bill Section

VTA

Contact Section

INIT

TELNO

EMAIL

Administrative Section	PG	OF

PON*	PRE	CC*

(Note: “PRE” is part of the PON and indicates a pre-order request. Do NOT include the “PRE” in the PON field of the LSR when submitting the firm order request)

End User Information Section

NAME

SAPR	SANO	SASF	SASD

SASN

SATH	SASS	LD1	LV1

LD2	LV2	LD3	LV3

AAI

CITY

STATE	ZIP

CPE MFR	CPE MOD

Administrative Section	PG	OF

PON*	pre	CC*

(Note: “PRE” is part of the PON and indicates a pre-order request. Do NOT include the “PRE” in the PON field of the LSR when submitting the firm order request)

Hunt Group Identification Section

Hnum	HNTYP	HTNqty

Hnum	HNTYP	HTNqty

Hnum	HNTYP	HTNQty

Hnum	HNTYP	HTNQty

Hnum	HNTYP	HTNQty

Hnum	HNTYP	HTNQty

Hnum	HNTYP	HTNQty

Hnum	HNTYP	HTNQty

Hnum	HNTYP	HTNQty

Hnum	HNTYP	HTNqty

Hnum	HNTYP	HTNQty

Hnum	HNTYP	HTNQty

Hnum	HNTYP	HTNQty

Hnum	HNTYP	HTNQty

Hnum	HNTYP	HTNQty

Hnum	HNTYP	HTNQty

Hnum	HNTYP	HTNQty

Hnum	HNTYP	HTNQty

Hnum	HNTYP	HTNQty

Administrative Section	PG	OF

PON*	pre	CC*

(Note: “PRE” is part of the PON and indicates a pre-order request. Do NOT include the “PRE” in the PON field of the LSR when submitting the firm order request)

Facility & Service Detail Section

QR ISDN	ISDNP	BRIQTY	LST

LNUM	LNa	ECCKT

FEATURE	FEATURE DETAIL

LNUM	LNa	ECCKT

FEATURE	FEATURE DETAIL

LNUM	LNa	ECCKT

FEATURE	FEATURE DETAIL

LNUM	LNa	ECCKT

FEATURE	FEATURE DETAIL

LNUM	LNa	ECCKT

FEATURE	FEATURE DETAIL

LNUM	LNa	ECCKT

FEATURE	FEATURE DETAIL

LNUM	LNa	ECCKT

FEATURE	FEATURE DETAIL

Effective - 11/13/10 063128

BRI (Basic Rate) ISDN Form

(For Complex Preorder Use Only)

Effective - 11/13/10 063227

Effective - 11/13/10 063326

Effective - 11/13/10 063425

Local Hunting Service Request

RB0055526

2010-09-30

SBC