Bundled Switched Service LD/Local
SECTION 1. ACC BUSINESS REPRESENTATION | |
|Agent / Retention Manager |
| |
|Agent Contact Person |Sub-Agent Contact Person |
| | |
|Agent Email Address |Sub-Agent Email Address |
| | |
|Agent Phone # |Agent Channel ID # |Sub-Agent Phone # |Sub-Agent Channel ID # |
| | | | |
|SECTION 2. ACCOUNT INFORMATION (Reference only one Service Address per order form) |
|Please note that the fields in sections I, II, and III are required |
|COMPANY INFORMATION |BILLING INFORMATION (if different than company information) |
|I. Company Name (Service Company Name) |II. Bill To: |
| | |
| | |
| | |
| | |
| | |
|Company Address |Street |
| | |
|City |State |Zip Code |City |State |Zip Code |
| | | | | | |
|Contact Person |Phone Number |Billing Contact Person |Billing Contact Phone Number |
| | | | |
|Contact Fax Number |Contact Email Address |Billing Contact Email Address |
| | | |
|III. REQUIRED FOR ALL: Legal Company Name (Parent Company) |
| |
|SECTION 3. SERVICE REQUEST SUMMARY |
| |SWITCHED LONG DISTANCE | |
| |SWITCHED TOLL FREE |Quantity of New 8YY # s | |Quantity of RespOrg #’s | |
| |BUSINESS CALLING CARD | |
| |SWITCHED LOCAL SERVICE** | |
|SECTION 4. BILLING OPTIONS (refer to Billing Options document, found on A.I.M.) |
| STANDARD BILLING (Single Account Billing) |
| MULTI-ACCOUNT BILLING (Please provide separate Service Agreements for Each Account) |
|Multi-Account Service Option: 1 2 Location # of |
|Headquarters Account Name (Company): |
| CORPORATE BILLING†: $6.50/mo. Administrative Fee† plus $3.00/mo. each service location† |
|Corporate Billing Option: 1 2 3 4 |
|Corporate Billing: Is the above Service address the Headquarters Location? Y N |Corporate Billing: Location # of |
|†Charges marked by † are not stabilized for the Term, are illustrative to reflect the current Service Guide rates and will vary in accordance with the |
|corresponding charges set forth in the Service Guide. |
|Billing Report Options (please provide supporting paperwork): | Access-a-Bill† $19.95 per month | a la carte Tele-management Reports† |
| | |$0.99 per month per report |
|Billing Cycle (Bill Date Preference) | |
**ACC BUSINESS SWITCHED LOCAL SERVICE IS ONLY AVAILABLE WITH ACC BUSINESS LONG DISTANCE
SERVICE, WHICH INCLUDES: LOCAL TOLL, INTERLATA AND INTERNATIONAL.
|SECTION 5A. LONG DISTANCE ACCOUNT DETAIL INFORMATION |
| | | New Account |
|Customer’s Average LD Monthly Usage (minutes) |Expected LD Monthly Revenue |Existing Account Acct# |
| | (dollars) | |
|Mandatory Account Codes? Yes Mandatory Reserved Account Codes? Yes (ICB Required) |
|If Existing Account: |
|Current LD/Local Toll Plan |Rates/Term/MMUC: |Switched |Dedicated |
|Are you retaining the same rates/ term/MMUC Plan? |Yes Current contract/term/ MMUC |No New contract/term/ MMUC selected below |
| |continues | |
|SECTION 5B. LONG DISTANCE SERVICE TERM, CHARGES, RATE PLANS, AND PROMOTIONS |
|Domestic Switched Rates/Term Plans/|Switched InterSTATE With Local |Switched InterSTATE Without Local |InterLATA†/ |IntraLATA†/ Local Toll† |
|Minimum Monthly Usage Commitment | | |IntraSTATE† | |
|(MMUC) | | | | |
|12 Month Term & MTM | | | | |
|24 Month Term | | | | |
|36 Month Term | | | | |
| |Quote Letter and MARC pricing |Quote Letter and MARC pricing |Quote Letter and MARC |Quote Letter and MARC |
| |schedule attached with interstate |schedule attached with interstate |pricing schedule attached |pricing schedule attached |
| |rate(s) |rate(s) |with instate rate(s) |with instate rate(s) |
|The above rates do not apply to mobile termination. Mobile termination† rates are located in the Service Guide. |
|International Rate Plans† (select one):| Standard† ___ | Supersaver† ___ | Quote Letter and MARC pricing schedule attached for special |
| | | |international rate(s) to select countries |
|Promo Code (provide code/s): ___ Special rates and terms may apply with certain promo codes |
|†Charges marked by † are not stabilized for the Term, are illustrative to reflect the current Service Guide rates and will vary in accordance with the corresponding|
|charges set forth in the Service Guide. |
|Customer shall pay ACC Business for use of long distance outbound and toll free inbound service at the rates set forth in the Service Guide located at: |
|. The Customer Agrees to satisfy the Minimum Monthly Usage Commitment (MMUC) as selected above. The MMUC will be satisfied by the|
|following “Eligible Charges”: All intrastate, interstate and international gross monthly charges, except for taxes, discounts, Payphone Use Charges and PICC, that |
|are billed to the Customer’s AT&T Business Service Main Billed Account will contribute toward meeting the Minimum Monthly Charge. If on any month of the Term, the |
|Customer has failed to satisfy the MMUC for the preceding month, the Customer will be billed a shortfall charge in an amount equal to the difference between the |
|MMUC and the total of the actual MMUC-Eligible Charges incurred during that month |
|SECTION 5C. ACC BUSINESS SWITCHED LONG DISTANCE (for additional lines, see Exhibit A) |
|Telephone Number |Cust. Code|Line Type |BTN |LD |Local Toll |Acct Code |CNTRX |
| | |(ex: fax, modem, office department) |WTN |(Y/N) |(Y/N) |(Y/N) |(Y/N) |
|1 | | | | | | | | |
|2 | | | | | | | | |
|3 | | | | | | | | |
|4 | | | | | | | | |
|Do you have a PIC freeze on the lines that are the subject of this order? |
|PIC Freeze: |No |Yes |If Yes, DATE the PIC freeze is removed from all lines: |
|IMPORTANT: Service cannot be switched over to ACC Business if there is a PIC freeze in place on the service. |
|SECTION 5D. TOLL FREE SERVICES (800 / 888 / 877) - $ 5/mo. For each new number |
| | |New |Block Pay Phone | D.A. |Service Area |
|Toll Free Number |Ring To Number (RTN) |(Y/N) |(Y/N) |(Y/N) |US/US+Can |
| | | | | | |
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| | | | | | |
| | | | | | |
| | | | | | |
|SECTION 5E. BUSINESS CALLING CARD |Will these cards be used from outside the U.S. and Canada? (Y/N): |
|If Switched Interstate with Local rates were selected, then a separate standalone Switched Long Distance MUC, term and interstate rate must be selected for |
|Business Calling Card in Section 5B. |
|Company or Customer Name On Card |Int’l Dialing (Y/N) |Countries Typically Called To/From Using Calling Card |
| |(If yes list countries) | |
| | | |
| | | |
|SECTION 5F. SWITCHED LOCAL SERVICE |This is only available as a bundled service with LD/Local Toll |
| |NOTE: Switched Local rates are MTM (not part of a dedicated local service term plan, if |
| |applicable) |
|Current LEC: |Current CLEC (if applicable): |
| Full Port Partial Port |Account Type: L01 (Care) L02 (Agent or Retention) |
|Customer’s Average Mo. Usage (minutes) |Expected Monthly Revenue |
|Local Service Rate (per line) |Flat Rate: | Measured Rate: Line Fee Per Min. |
|FSLC/EUCL Charges, per line: ___ |
|Promo Name/Code (provide name/code/s): ___ |
| Quote letter and MARC pricing schedule attached with Switched local rate(s), if applicable |
|If Local service is unavailable, may ACC Business proceed|If Yes, please ensure “Domestic Switched Interstate Rates without Local” & | Yes |
|with the rest of the order? |“Minimum Usage Charge without Local” are completed. | |
| |If No, ACC Business will cancel this Order Request for Service | No |
|SECTION 5G. LOCAL DIRECTORY LISTING INFORMATION |
|For all phone numbers to be published, select option: |Listed (with Directory Assistance): Yes No |
|White-only Pages: Both White & Yellow Pages: | |
|Indicate Yellow Page Heading (e.g., “Cabinet Makers”. Refer to a directory for acceptable headings): |
|Additional Listings |Quantity |Monthly Recurring Charge per listing |Non-Recurring Charge per listing |
| | | | |
|Non-Listed / Non-Published |Quantity |Monthly Recurring Charge per listing |Non-Recurring Charge per listing |
| | | | |
|Section 5H. SWITCHED LOCAL SERVICE INFORMATION/FEATURES |
|Select Features Below: If additional pages or BTNs are needed, please use Exhibit A. |
| |Monthly |BTN |WTN |WTN |WTN |WTN |WTN |
|Feature Requested |Feature | | | | | | |
| |Charge ($) | | | | | | |
| |Per Line | | | | | | |
|Hunting (provide |No Charge | | | | | | |
|sequence A1, A2, B1, | | | | | | | |
|B2, etc.) | | | | | | | |
|Published # (Y/N) | | | | | | | |
|Add’l Directory | | | | | | | |
|Listing (Y/N) | | | | | | | |
|Voice Mail | | | | | | | |
|Voice Mail with Paging| | | | | | | |
|Deluxe Voice Mail | | | | | | | |
|Deluxe Voice Mail w/ | | | | | | | |
|Paging | | | | | | | |
|Deluxe Voice | | | | | | | |
|Multi-Mail (Y/N) | | | | | | | |
|Voice Mail Forwarding | | | | | | | |
|Call Waiting (Y/N) | | | | | | | |
|Caller ID (Y/N) | | | | | | | |
|Caller ID with Name | | | | | | | |
|(Y/N) | | | | | | | |
|Speed Dialing (Y/N) | | | | | | | |
|Outbound Blocking Pkg | | | | | | | |
|Inbound Blocking (Y/N)| | | | | | | |
|Call Forward Busy | | | | | | | |
|(Y/N) | | | | | | | |
|Call Forward No Ans | | | | | | | |
|(Y/N) | | | | | | | |
|Call Fwd Remote Access| | | | | | | |
|(Y/N) | | | | | | | |
|Call Forward Variable | | | | | | | |
|(Y/N) | | | | | | | |
|Distinctive Ringing | | | | | | | |
|(Y/N) | | | | | | | |
|Caller ID Block Per | | | | | | | |
|Line (Y/N) | | | | | | | |
|Selective Call | | | | | | | |
|Rejection (Y/N) | | | | | | | |
|Three-Way Calling | | | | | | | |
|(Y/N) | | | | | | | |
|SECTION 5I. SWITCHED LOCAL SERVICE AND VOICE MAIL NOTES: |
|Is this Brand New Local Service? (no existing switched local service): Yes No |
|If Yes to Brand New Service: List NPA/NXX/Line # of Neighboring Business: |
|List Number of Locations: List Number of Brand New Lines per Location: |
|Voice Mail Set-up: The most popular Voice Mail option is to have all sequential hunting lines included in Voicemail. |
|This includes: 1) VM on the first line, 2) Hunting is on all lines except the last line, 3) Call Forwarding No Answer on all lines, |
|4) Call Forwarding Busy on the last line, and 5) Voice Mail Forwarding on all lines except the first line |
|Do you want your Voice Mail provisioned this way? Yes No If No, please explain in Notes section below, detailing how you would like your Voice Mail |
|provisioned. |
|Voice Mail Paging Information: (Note: See Feature Job Aid Page 4 for pager information) |
|8XX Pager #: Pager PIN # Pager Company: |
|LONG DISTANCE, LOCAL SERVICE and VOICE MAIL NOTES: |
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|SECTION 6. TERMINATION |
|SECTION 6A |
|The Customer may terminate service without incurring Termination Charges prior to the end of the service term, provided the Customer is current in payment to ACC |
|Business for services provided and replaces this Pricing Schedule with other domestic and/or international telecommunications services provided by ACC Business |
|having a new revenue commitment equal to or greater than the revenue commitment set forth in this Pricing Schedule. |
|SECTION 6B |
|In the event of a termination of this Pricing Schedule, either by the Customer for its convenience (other than under Section 6.A) or by ACC Business as permitted |
|for cause under the Agreement, then the Customer must pay a Termination Charge equal to 35% of the MUC selected for each month remaining in the service term. |
|SECTION 6C |
|ACC Business may terminate this Pricing Schedule, in the event that (i) ACC Business determines that Special Construction is necessary for ACC Business to provide |
|the Service hereunder and (ii) Customer does not execute and return an ACC Business Special Construction Pricing Schedule within the time period designated by ACC |
|Business. Customer will not incur any Termination Charges in the event that ACC Business exercises its right of termination under this paragraph. |
|SECTION 7. TAX EXEMPT INFORMATION |
| Tax Exempt. Certifications for all jurisdictions that apply must be attached: Federal State County City |
| Reseller. FCC Forms 214 & 499 must be attached. |Applicable taxes will be applied to all invoices until supporting tax exempt |
| |documentation is provided. |
|SECTION 8. |
|SIGNATURE BELOW BY YOUR AUTHORIZED REPRESENTATIVE IS YOUR CONSENT TO THE |
|TERMS AND CONDITIONS OF THIS AGREEMENT |
|If you are a month-to-month customer, the terms and conditions set forth in ACC Business standard Business Communications Services Agreement found at |
| apply to your month-to-month services that have been detariffed, and the applicable AT&T tariffs apply to your month-to-month service that |
|remains tariffed. As your tariffed month-to-month services are detariffed, they will also be covered by the terms and conditions set forth in ACC Business standard|
|Business Communications Services Agreement. Specific service descriptions and additional service terms, conditions and charges can be viewed at |
|. |
| |
|If you are a term plan customer, the terms and conditions as specified in the CSOA apply to your term plan services that have been detariffed, and the applicable |
|AT&T tariffs apply to your term plan services that remain tariffed. As your tariffed term plan services are detariffed, they will also be covered by the attached |
|general terms and conditions in the CSOA. Following expiration of the term or other termination of your term plan agreement, if you continue to receive any term |
|plan services and do not enter into a new term plan agreement, the terms and conditions set forth in ACC Business standard Business Communications Services |
|Agreement found at will apply to your services. Specific service descriptions and additional service terms and conditions can be viewed at |
|, however, all Service Level Agreements set forth in the Service Guide shall not apply, and are specifically excluded (and |
|Customer shall be ineligible for any credits thereunder) with respect to all Service provided to Customer by ACC Business under this Pricing Schedule. |
| |
| |
|Provided that ACC Business furnishes the same service(s) or feature(s) that I have with my current service provider but have not been discussed today, I authorize |
|ACC Business to add any such service(s) or feature(s) to my new ACC Business local account. |
| |
|Customer |ACC Business |
|Name (Printed) |Name (Printed) |
| | |
|Signature (x) |Signature (x) |
|Company Name |Title |
| |Contract Specialist |
|Title |Date |
| | |
|Date | |
| | |
EXHIBIT A
|ACC BUSINESS LONG DISTANCE |
|Telephone Number |Cust. Code |Name |BTN |Acct Code (Y/N) |CNTRX |
| | | |WTN | |(Y/N) |
|5 | | | | | | |
|6 | | | | | | |
|7 | | | | | | |
|8 | | | | | | |
|9 | | | | | | |
|10 | | | | | | |
|11 | | | | | | |
|12 | | | | | | |
|13 | | | | | | |
|14 | | | | | | |
|15 | | | | | | |
|16 | | | | | | |
|17 | | | | | | |
|18 | | | | | | |
|19 | | | | | | |
|20 | | | | | | |
|ADDITIONAL TOLL FREE NUMBERS |
|Toll Free Number |Ring Into Number |New |Block Pay Phone |D.A. |Service Area |
| | |(Y/N) |(Y/N) |(Y/N) |US/US+Can |
| | | | | | |
| | | | | | |
| | | | | | |
|ADDITIONAL BUSINESS CALLING CARD |
|Company or Customer Name On Card |Int’l Dialing (Y/N) |Countries Typically Called To/From Using Calling |
| |(If yes list countries) |Card |
| | | |
| | | |
| | | |
|Customer Acceptance: |
|Sign/Initial:___________________________________________________Date:___________________________________ |
EXHIBIT A, CONT’D.
|SWITCHED LOCAL SERVICE INFORMATION/FEATURES |
| |Monthly |BTN |WTN |WTN |WTN |WTN |WTN |
|Feature Requested |Feature | | | | | | |
| |Charge | | | | | | |
| |$/Line | | | | | | |
|Hunting (provide |No Charge | | | | | | |
|sequence A1, A2, B1, | | | | | | | |
|B2, etc.) | | | | | | | |
|Published # (Y/N) | | | | | | | |
|Add’l Directory | | | | | | | |
|Listing (Y/N) | | | | | | | |
|Voice Mail | | | | | | | |
|Voice Mail with Paging| | | | | | | |
|Deluxe Voice Mail | | | | | | | |
|Deluxe Voice Mail w/ | | | | | | | |
|Paging | | | | | | | |
|Deluxe Voice | | | | | | | |
|Multi-Mail (Y/N) | | | | | | | |
|Voice Mail Forwarding | | | | | | | |
|Call Waiting (Y/N) | | | | | | | |
|Caller ID (Y/N) | | | | | | | |
|Caller ID with Name | | | | | | | |
|(Y/N) | | | | | | | |
|Speed Dialing (Y/N) | | | | | | | |
|Outbound Blocking Pkg | | | | | | | |
|Inbound Blocking (Y/N)| | | | | | | |
|Call Forward Busy | | | | | | | |
|(Y/N) | | | | | | | |
|Call Forward No Ans | | | | | | | |
|(Y/N) | | | | | | | |
|Call Fwd Remote Access| | | | | | | |
|(Y/N) | | | | | | | |
|Call Forward Variable | | | | | | | |
|(Y/N) | | | | | | | |
|Distinctive Ringing | | | | | | | |
|(Y/N) | | | | | | | |
|Caller ID Block Per | | | | | | | |
|Line (Y/N) | | | | | | | |
|Selective Call | | | | | | | |
|Rejection (Y/N) | | | | | | | |
|Three-Way Calling | | | | | | | |
|(Y/N) | | | | | | | |
|Customer Acceptance: Sign/Initial: ________________________________________Date:___________________________ |
|Customer Name: |AT&T |Customer Account #: |
| | | |
|Customer Full Address & Zip: |AT&T Full Address & Zip: |Customer Contact: |
| |400 West Avenue |Tel. #: |
| |Rochester, NY 14611-0000 |AT&T Contact: |
| | |Tel. #: |
| | |Email ID: |
|Agent Name: |Agent ID: |
| 1.I appoint AT&T as my agent to handle all arrangements with the Local Exchange | 2. It is understood that: Only one carrier may be designated for Long |
|Company(s) (LEC) for establishing or changing ACC Business Long Distance Service, |Distance Service, Only one carrier may be designated for ‘Local Toll’ |
|‘Local Toll’ Service, Local Service and International Service. AT&T may offer such |Service, Only one carrier may be designated for Local Service, Only one |
|service for all telephone lines associated with the main Billed Telephone Number(s) |carrier may be designated for International Service for each designated |
|(BTNs) listed below or in the attachment, and to issue instructions to and to |telephone number and that the selection of more than one carrier for either|
|otherwise deal with the LEC regarding the BTNs. |Long Distance Service, ‘Local Toll’ Service, Local Service, or |
| |International Service will invalidate any choice. |
| 3. It is further understood that during the initial Presubscription period for ‘Local Toll’ Service, as defined by the state governing body, the PIC change |
|charge may be waived for an initial time period. However, it is acknowledged that a charge per line may be applied by the local telephone company for subsequent|
|changes |
|4. This Appointment is for: |Long Distance (InterLATA) Service | YES NO |
| |Local Toll Service | YES NO |
| |Local Service | YES NO |
| |International Service | YES NO |
|5. This Appointment is APPLICABLE TO THE|Blanket LOA | YES NO |
|FOLLOWING LOCATIONS |(For all locations in the United States; AT&T will maintain a list of such | |
| |locations and Billed Telephone Numbers as attached) | |
|(CHOOSE ONE) |Location Specific LOA | YES NO |
| |(Specify applicable location and Billed Telephone Numbers and/or Working Telephone| |
| |Numbers as attached) | |
|6. This Appointment revokes any prior appointments for the services involved here and may be revoked at any time. |
|ORDERED BY CUSTOMER: |ACCEPTED BY AT&T: |
|7. Signature: |11. Signature |
|8. Printed Name: |12. Printed Name: |
|9. Title: |13. Title: |
|10. Date: |14. Date: |
List of Locations
|Location Addresses |Location BTN’s |Location WTN’s |
| | |(Insert WTN or state “PIC All”) |
| | | |
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