Fcc Form 474 - Schools And Libraries Universal Service Service Provider Invoice

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FCC Form 474
Do not write in this space.
Approved by OMB
Do Not Staple This Form
OMB Control No. 3060 – 0856
Estimated time per response: 1.0 hour
Schools and Libraries Universal Service
Service Provider Invoice FCC Form 474
Please read instructions before completing
This form can be filed online or by mail.
Service Provider Form Identifier (Create an identifier for your own reference)
FCC Form 474 Invoice # ________________________________________
(To be inserted by administrator)
BLOCK 1: Service Provider Information
1. Service Provider Name
2. Service Provider Identification Number (SPIN)
3. Contact Person’s Name
4. Contact Telephone Number Area Code:
Phone Number:
Ext.
Contact Fax Number
Area Code:
Fax Number:
Contact Email Address
5.
Total Invoice Amount (total of Block 2, Column 13)
Page 1 of 4
FCC Form 474
July 2013

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