This form must be filled out in its entirety for all IUP subscribers; if you have questions, contact the West Safety Services DIU at (855) 804-0490. Please email your completed form to ATTIUP.safetyservices@west.com.

Date:

Subscription is: (check one)	New	Update	User or Name Change	Delete
Select User Type:

CLEC Limited 1

MSAG View

TN View

TN CR

ALI DR

CLEC Limited 2

MSAG View

TN Update

TN CR

TN Error

ALI DR	ILEC Full

MSAG CR

MSAG Update

TN Update

TN CR

TN Error

ALI DR
Will this user submit SOI directly to West Safety Services?	Yes	No

If Yes, enter File Format (i.e. NENA 2, NENA 3.1, etc.):
USER CONTACT INFORMATION

(To be filled out by the end user)
User Name/Job Title:
Company:
Entrust Token:	New

Use Existing Token: Serial Number:
Connect Enterprise Mailbox:

Note: Shared mailboxes may be used if all users have access to the same region(s).	New

Use Existing sFTP or Connect Enterprise Mailbox

Mailbox Name:
Supervisor Name/ Email Address:
Mailing Address:
Physical Address (if different from mailing):
Telephone Number:

Fax Number:
Email Address:
E9-1-1 Region/ State(s):	CA	NV
If this is a user or name change, provide the name or the IUP User ID of the person being replaced or changed:
If this is an ILEC Account, provide the name(s) of the associated PSAP(s):

User Data Restriction(s)
Please list your NENA Company ID (COID). The COID is generally 3-5 characters and/or digits (such as: PS611 or VZW). If there is more than one COID, please list them all in the highlighted COID field.

Note:	To request the same access as an existing user, provide their name or IUP user ID below.

TN Query
New (enter restriction(s) below)	Same as (enter existing user name)
County	Community	MSAG Sys	Exchange	COID(s)	ESN(s)

TN Update
New (enter restriction(s) below)	Same as TN Query above
County	Community	MSAG Sys	Exchange	COID(s)	ESN(s)

TN Error
New (enter restriction(s) below)	Same as TN Update above
County	Community	MSAG Sys	Exchange	COID(s)	ESN(s)

MSAG Query (ILEC Only)
New (enter restriction(s) below)	Same as (enter existing user name)
County	Community	MSAG Sys	Exchange	ESN(s)

MSAG Update (ILEC only)
New (enter restriction(s) below)	Same as MSAG Query above
County	Community	MSAG Sys	Exchange	ESN(s)

AT&T West IUP Subscriber Form – ILEC and CLEC

West Proprietary v04.07.2017	Page | 1

IUP Subscriber Form

Campbell, Lennie

2017-09-25

MARTINEZ, CHERYL A

Intrado Inc.