Wholesale: Products & Services

Move 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.


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)
* 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