Gpsc Form 200-1 - Payphone Service Provider Registration September 2007 printable pdf download

Gpsc Form 200-1 - Payphone Service Provider Registration September 2007

GEORGIA PUBLIC SERVICE COMMISSON

PAYPHONE SERVICE PROVIDER REGISTRATION

PROVIDER’S NAME:

__________________________________________

PROVIDER’ ADDRESS:

__________________________________________

(Principal Office)

__________________________________________

TELEPHONE NUMBER:

__________________________________________

FAX NUMBER:

__________________________________________

E-MAIL ADDRESS:

__________________________________________

CONTACT PERSON:

__________________________________________

PHONE NUMBER:

__________________________________________

IF THE PROVIDER’S PRINCIPAL OFFICE IS NOT LOCATED IN THE

STATE OF GEORGIA, PLEASE PROVIDE THE FOLLOWING ADDITIONAL

INFORMATION.

NAME AND TELEPHONE NUMBER OF PROVIDER’S REGISTERED

AGENT IN GEORGIA:

____________________________________________________________

This registration must be submitted to:

Reece McAlister

Executive Secretary

Georgia Public Service Commission

244 Washington Street, S.W.

Atlanta, Georgia 30334

FOR COMMISSION USE:

PSP ID Number:

_________________

GPSC FORM 200-1, Revised: 09/11/07

Electronic Version

Gpsc Form 200-1 - Payphone Service Provider Registration September 2007