Choice Network Solutions :: Top of the Telco Chain

Products & Services

>	Verizon Wireless

>	MPLS (Multi-Protocal Label Switching)

>	Transparent LAN / Metro Ethernet (TLS)

>	Internet Access DSL, Dedicated Access

>	Frame Relay / ATM / Packet Networks

>	Private Lines Sub-T1, DS1/T1, DS3/T3, OC-3 OC-12, OC-48

>	Long Distance Switched Voice / Dedicated Voice / Data

>	Equipment Data – Routers, Switches and more Voice – Phone Systems and more

>	ISDN PRI & BRI

>	Flexgrow Bundled T1 Services

>	Voice Local Lines / Centrex

First Contact Info

Customer Information
Billing Name:
*Billing Telephone Number (BTN):
Billing Address:
Suite, floor, building, etc:
City:
State:
Zip:
Main Contact's Name:
Main Contact's Phone #:
Main Contact's Fax #:
Main Contact's Email:

Primary Install Address
Street:
Suite, floor, building, etc:
City:
State:
Zip:
On Site Contact's Name:
On Site Contact's Phone #:
On Site Contact's Cell #:
*Working phone number on premise:
Comments:

Secondary Install Address (if applicable for T-1s, moves or nailed down BRIs)
Street:
Suite, floor, building, etc:
City:
State:
Zip:
On Site Contact Name:
On Site Contact Phone #:
On Site Contact Cell #:
*Working phone number on premise:
Comments:

Additional Information
Long Distance PIC:
Present Local Carrier:
If not Verizon, Name of CLEC:
Long Distance Rep's Name:
Long Distance Rep's Phone #:
Long Distance Rep's Email:
Equipment Vendor's Name:
Equipment Vendor's Phone #:
Equipment Vendor's Email:
Internet Service Provider:
ISP representative or contact (if known):
Comments: