Colorado Universal Service Charge Payment Notice Template - Quarter 2001 - State Of Colorado Department Of Regulatory Agencies

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STATE OF COLORADO
PUBLIC UTILITIES COMMISSION
Department of Regulatory Agencies
M. Michael Cooke
Raymond L. Gifford, Chairman
Executive Director
Polly Page, Commissioner
Jim Dyer, Commissioner
Bruce N. Smith, Director
Bill Owens
Governor
COLORADO UNIVERSAL SERVICE CHARGE PAYMENT NOTICE
QUARTER 2001
Contact Person:
Invoice Date
Deadline for Contribution
Payments must be received by this date.
Contributor Name
Estimated Contribution
$
Make Your Check Payable To:
QWEST Corporation
Write This Account Number on Check
#97237230
Send Payment To:
U.S. Bank National Association
CM-9705
P.O. Box 70870
St. Paul, MN 55170-9705
Electronic Funds Transfer Information
BBK: U.S. Bank N.A. (ABA #091000022)
BNF: U.S. Bank Trust N.A./AC #180121167365
OBI: TFM/AC #47300017
Ref: Account #97237230/US West Colorado High Cost
Deposit Escrow
Actual Amount of Payment
$______________________
Date of Payment
____/____/____
Check Number
______________
Penalty for Late Payment
1% per month if paid after
* See reverse side for an explanation of the Colorado Universal Service Charge.
If you have any questions concerning this notice, please contact Jamie Jack.
Phone:
303-894-2043
Fax:
303-894-2065
Email:
jamie.jack@dora.state.co.us
Please notify me when payment has been made. Thank you!
1580 Logan Street, Office Level 2, Denver, Colorado 80203 303-894-2000
Consumer Affairs 303-894-2070
Permit and Insurance (Outside Denver) 1-800-888-0170
Consumer Affairs (Outside Denver) 1-800-456-0858
V/TDD 303-894-7880
Fax 303-894-2065
Hearing Info 303-894-2025

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