Wholesale: Products & Services

Change Payphone Services Order

This form is to be used by Vendors and End Users to request Payphone service changes.

* denotes a required field.

State Public Service Commission Certificate Number (if applicable):
Order Activity: *
Existing Telephone Numbers to perform activity requested: *
Date Ordered: *
Desired Due Date: *

Confirmation Type: *
E-mail Address:
FAX Tel #:

Location Name: *
Location Address: *
City: *
State: *
ZIP: *
Quantity of Lines: Over ten lines? Yes No
Site Contact Name: *
Site Contact Number: *
Billing Name of Payphone Company:
Billing Contact Name:
Billing Contact Telephone Number:
Billing Address:
City:
State:
ZIP:

PIC's: *

InterLATA or No Pic
IntraLATA or No Pic

PIC Restriction: * Yes No
Major Account Number if Applicable:
MDES Number if Applicable:
Purchase Order Number: *
Related Purchase Order Number:
Vendor Name: *
Vendor Contact Number: *
Requested Termination Location: *
Note: Demarcation point must be in compliance with CenturyLink local interface location practice.
 
Line Type: *
Note: A Coin Line is a Smart line that has a higher monthly charge than B-1 and includes additional features. Please see CenturyLink local tariff for specific services included in Coin-lines where available.

Blocking:

Some services may not be available in all areas and others may be CenturyLink tariff required.

Note: It is standard practice on every payphone order to block ALL "Pay Per Use" services, to add a Flex Ani 70 code and to request the line be tagged and labeled. You do not need to specify this information on each request.

*
Yes No International Block
Yes No Operator Screening
Yes No 900/976 Block
Yes No Billed Number Screening
Yes No Incoming
Yes No Coin Control
Yes No 0+
Yes No Answer Supervision
Yes No 1+ (allows 800)
Other*:
* Please list any other block requested.

Signaling: *
Do you need CenturyLink to perform any inside wiring installation? *
Comments and Special Instructions:
Do you have this customer's LOA? *
If yes, please qualify with one of the following:
Blanket LOA on file with CenturyLink
Will be faxing customer LOA to 866-764-8609