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	SECNCI

sup

REMARKS

Bill Section

VTA

Contact Section

INIT

TELNO

fax

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

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)

Circuit Information Section

Cktqty	svc Cd

FEATURE

FEATURE DETAIL

FEATURE

FEATURE DETAIL

FEATURE

FEATURE DETAIL

FEATURE

FEATURE DETAIL

FEATURE
FEATURE DETAIL

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)

Primary Location (PRILOC) Information Section

legnum	prinam

Cfa

priloc

SAPR	SANO	SASF	SASD

SASN

SATH	SASS	LD1	LV1

LD2	LV2	LD3	LV3

AAI

CITY

STATE	ZIP

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)

Secondary Location (SECLOC) Information Section

legnum	SECname

Cfa

secloc

SAPR	SANO	SASF	SASD

SASN

SATH	SASS	LD1	LV1

LD2	LV2	LD3	LV3

AAI

CITY

STATE	ZIP

Effective - 11/13/10 066112

Resale Private Line Reduced Input Form

(For Complex Preorder Use Only)

Effective - 11/13/10 066211

Effective - 11/13/10 066310

Effective - 11/13/10 066419

Effective - 11/13/10 066518

Local Hunting Service Request

RB0055526

2010-09-30

SBC