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 |

|      |      |    |    |    |      |

|      |      |    |    |    |      |

|      |      |    |    |    |      |

|      |      |    |    |    |      |

|      |      |    |    |    |      |

|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:       |

| |

| |

| |

| |

| |

| |

|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”) |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download