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Form Telecommunications Relay Service (Trs) Fee Report - Public Service Commission Of West Virginia

PUBLIC SERVICE COMMISSION OF WEST VIRGINIA

TELECOMMUNICATIONS RELAY SERVICE (TRS) FEE REPORT

MONTH OF _________________________

FEIN: __________________________________________

COMPANY NAME: ________________________________________________

DBA (IF APPLICABLE): ____________________________________________

MAILING ADDRESS: _______________________________________________

________________________________________________________________

CONTACT PERSON: ______________________________________________

TEL. NO: _______________________________

EMAIL ADDRESS: _________________________________________________

NUMBER OF ACCESS LINES SUBJECT TO THE FEE: ___________________

AMOUNT COLLECTED: $ ___________________

I certify that the above figures are true and accurate to the best of my knowledge.

Signature: ________________________________________________________

Title: ______________________________ Date: ________________________

TRS REMITTANCES MUST BE SENT, BY THE 20TH OF EACH MONTH, TO:

BB&T

Atten: Diana Chandler

Trust & Investments

P.O. Box 1793

Charleston, WV 25326

The remittance should be payable to WV TRS, Escrow Account #56345670

When the deposit is made, the report showing the number of access lines and the amount of the

deposit should be sent (postal mail, fax or email may be used) to:

David Howell

West Virginia Public Service Commission

PO Box 812

Charleston, WV 25323

Tel: 304-340-0451

Fax: 304-340-0326

dhowell@psc.state.wv.us

Form Telecommunications Relay Service (Trs) Fee Report - Public Service Commission Of West Virginia