LONG DISTANCE QUOTE REQUEST FORM
Company Name: * Service Location: Street Address: * Service Address: City: * Service Address: State: * Servie Address: Zip Code: * Service Address: Phone Number: * Contact Person: Name: * Contact person: Email Address: * Contact person: Phone Number: * Type of Long Distance Rates Requesting: Dedicated Long Distance (over T-1 or DS3) Switched Long Distance (over Copper) BOTH Most Important Rate Needed: Dedicated Outbound Interstate Dedicated Outbound Intrastate Dedicated Inbound Interstate Dedicated Inbound Intrastate Switched Inbound Interstate Switched Inbound Intrastate Switched Outbound Interstate Switched Outbound Intrastate If Switched LD is requested who is local Carrier?: RBOC (Verizon, SBC, Bell South, Qwest) Local CLEC Other (ILEC) What Term Plan will you sign?: 3 Year 2 Year 1 Year Month to Month What is the Monthly Volume Committment you can make? : $50,000 + $25,000 to $50,000 $10,000 to $25,000 $7500 to $10,000 $5000 to $7500 $2500 to $5000 $1000 to $2500 $500 to $1000 $0 to $500 TELL US THE RATE AND CARRIER YOU WANT TO WIN THE BUSINESS: Comments:
