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General Information

Billing Account Name: BusOrg ID: Customer PON:Bill to Site ID: TSP:

Order Information

Order Action: Interval: Customer Requeste

Contact Information

Primary Contact: Technical Contact:

Work Phone: Work Phone:

Email Address: Email Address:

Product Acceptance: Billing Contact:



24-Hour Contact: Fraud Contact:



Special InstructionsInsert special instructions here.

Terms and Conditions

Authorized Customer Signature: Date:

Authorized Customer Name: Title:

Cu

The Service(s) identified in this Customer Order are governed by and subject to the master agreement(s) and service schedule(s) (if any) between Level 3 and Custoprovided for under such affiliate master agreement) applicable to such Service(s). The Services stated herein shall have a month to month Service Term, subject toCustomer and ii) payment by Customer of any applicable disconnection charges. If t his Customer Order changes pricing for existing Services, such pricing change(smonth following Level 3's acceptance of this Customer Order.

In the event that Level 3 and Customer (or its affiliate as the case may be) have not executed a master agreement and/or applicable Service Schedule(s) with respecstandard Master Service Agreement/Service Schedule(s) (as of the date of this Customer Order) shall govern, a copy of which are available upon request.

Any Customer-provided Purchase Order referenced in this Customer Order shall be for Customers internal use only. Any terms and conditions contained in any Cushave no force or effect.

Notwithstanding any other provision hereof, neither party shall be liable for any damages for loss of profits, loss of revenues, loss of goodwill, loss of anticipated savireplacement services, or any indirect, incidental, special, consequential, exemplary or punitive damages arising out of the performance or failure to perform under thi

Relevant service detail documents, including without limitation, the Customer Quote, setting forth specific information regarding the Services ordered by Customer puattached hereto, are incorporated herein. In the event of conflict between the detail in the Customer Order and any of the attachments, the detail in this Customer O

Level 3 installation date to be communicated pursuant to the terms of the master agreement. Invoices are delivered monthly. Level 3 bills in advance for Service to bmonth, except for charges that are dependent upon usage of Service, which are billed in arrears.


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IP Toll FreCustomer Order For

2/9/20

Configuration Name: Account Consultant (PM) Branch:

Order Title (optional): CPM Accept Date:


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Customer Order Summary Level 3 Inte

Order Date: Customer Order #

Order Action:

Customer Requested Date:

Customer Information

Organization Name:

Bus Org ID:

Site Name:

Address:

City:State:

Zip:

Primary Contact:

Phone:

Fax: (optional)

E-mail:

Customer Service Name:

(if applicable)

Special Instructions:

Insert special instructions here.

Market Information

See attached Market Summary Sheet. (must be included for proper processing of the order)

Customer Approval

C

The Service(s) identified in this Customer Order are governed by and subject to the master agreement(s) and service schedule(s) (if any) between Level 3 and Customeprovided for under such affiliate master agreement) applicable to such Service(s). The Services stated herein shall have a month to month Service Term, subject to: i) Customer and ii) payment by Customer of any applicable disconnection charges. If this Customer Order changes pricing for existing Services, such pricing change(s) shmonth following Level 3's acceptance of this Customer Order.

In the event that Level 3 and Customer (or its affiliate as the case may be) have not executed a master agreement and/or applicable Service Schedule(s) with respect tostandard Master Service Agreement/Service Schedule(s) (as of the date of this Customer Order) shall govern, a copy of which are available upon request.

Any Customer-provided Purchase Order referenced in this Customer Order shall be for Customers internal use only. Any terms and conditions contained in any Customhave no force or effect.

Notwithstanding any other provision hereof, neither party shall be liable for any damages for loss of profits, loss of revenues, loss of goodwill, loss of anticipated savingsreplacement services, or any indirect, incidental, special, consequential, exemplary or punitive damages arising out of the performance or failure to perform under this Ag

Relevant service detail documents, including without limitation, the Customer Quote, setting forth specific information regarding the Services ordered by Customer pursu

attached hereto, are incorporated herein. In the event of conflict between the detail in the Customer Order and any of the attachments, the detail in this Customer Orde

Level 3 installation date to be communicated pursuant to the terms of the master agreement. Invoices are delivered monthly. Level 3 bills in advance for Service to be month, except for charges that are dependent upon usage of Service, which are billed in arrears.


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Toll Free Number New or Ported? Area of Service

IP Toll Free (if new)

IP Toll FreeInformation Sheet

2/9/2007

TF NumberQuantity

RespOrg(Customer or L3)


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Responsible Organization Letter of Authorization

As the end-user subscriber, or the authorized representative of an end-user subscriber, of certain Toll Free service numbers (the Customer), I hereby

authorize Level 3 Communications, LLC (KSW01) (Level 3) to be the Responsible Organization (Resp Org) for the following Toll Free service numb

New Resp Org ID:KSW01

Toll Free Number(s) Ring To Number(s) Area of Service

Customer InformationPrint Customer Name_____________________________________________________________________________

(As it appears on customers bill copy)

Address __________________________________________________________

City _____________________________________ State ___ ___ Zip ___ ___ ___ ___ ___ - ___ ___ ___ ___

Customer Contact ___________________________________Phone (___ ___ ___) ___ ___ ___ - ___ ___ ___ ___

Billing Account Number _______________________________Delivery Date: ___ ___ / ___ ___ / ___ ___

Authorized Signature __________________________________________________ Date _______________________

Print Name __________________________________________________________ Title ______________________________

Toll Free Portability _________________(FAX) ELS Portability _________________(FAX)

to

Current Carrier___________________

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__ __-__ __ __-__ __ __ __ __ __-__ __ __-__ __ __ __

I attest under penalty of law and as an authorized employee, or an authorized representative, of the Customer that the Customer is the exclusive end-user subscriber of the Toll Free service numbers listed above. The Customer assumes all liability for the use (including without limitation, authorized,

fraudulent or misappropriated) of traffic of any other end-user subscriber with regards to the Toll Free service numbers listed. In addition, I understandthat this request for a Resp Org change does not constitute an order for disconnect of service with my existing carrier(s). I, on behalf of the Customer,continue to accept responsibility for notifying my existing carrier(s) of any intention to disconnect and/or change my Toll Free service after designating thabove as my Resp Org for the Toll Free numbers listed above.

U.S CANADA CARIBBEA

U.S CANADA CARIBBEA

U.S CANADA CARIBBEA

U.S CANADA CARIBBEA

U.S CANADA CARIBBEA

U.S CANADA CARIBBEA

U.S CANADA CARIBBEA

U.S CANADA CARIBBEA

U.S CANADA CARIBBEA

U.S CANADA CARIBBEA


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Customer Information

Customer Name Toll Free Number

Product Instance ID (PIID)

Request Date Requested Due Date

Requestor Contact Phone

Blocking Information

Block Action Type State LATA

Comments/Special Instructions

Insert special instructions here.

Internal Information

Account Manager Account Manager Phone

Blocking FormIP Toll Free08/09/2006

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Account Manager Fax Account Manager Email


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TollFree TN Port Out FormNew Resp Org ID

Release Date

Bill Stop Date

Toll Free TN Begin Toll Free TN End Port out? (Y/N)

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