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

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)

Common Block Information Section

cb

qr	qr ISDN	BRIQTY	ISDNP

cpgqty

Secondary Location Information Section

SAPR	SANO	SASF	SASD

SASN

SATH	SASS

LD1	LV1	LD2	LV2

LD3	LV3

CITY

STATE	ZIP

Effective - 11/13/10 069120

Centrex/Centrex ISDN Form

(For Complex Preorder Use Only)

Effective - 11/13/10 069229

Effective - 11/13/10 069328

Effective - 11/13/10 069427

Local Hunting Service Request

RB0055526

2010-09-30

SBC