Administrative Section	PG	OF

PON*	PRE	cC*	ATN

(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)

REQTYP	ACT	SUP	VER	TOS	LST

NC	NCI	SECNCI

REMARKS

Contact Section

INIT	TELNO	FAX NO

End User Information

NAME

SAPR	SANO	SASF	SASD

SASN

SATH	SASS	LD1	LV1

LD2	LV2	LD3	LV3

AAI

CITY

STATE	ZIP CODE

CPE MFR	CPE MOD

Hunt Group Information (HGI) Request Information

HIDQR	HNTYP	HTNSQR

Effective - 11/13/10 061117

LSR/End User/Hunt Group

Information Reduced Input Form

(For Complex Preorder Use Only)

Local Hunting Service Request

RB0055526

2010-09-30

SBC