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Payphone Service Provider (Psp) Application For Certification - Public Service Commission Of South Carolina

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* OFFICE USE ONLY:

* CERTIFICATION NUMBER ____________ *

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PUBLIC SERVICE COMMISSION OF SOUTH CAROLINA

PAYPHONE SERVICE PROVIDER (PSP)

APPLICATION FOR CERTIFICATION

SECTION I: APPLICANT INFORMATION

______________________________________________________________________________

NAME IN WHICH CERTIFICATION TO BE ISSUED

______________________________________________________________________________

MAILING ADDRESS

______________________________________________________________________________

CITY, STATE, ZIP

______________________________________________________________________________

CONTACT PERSON or RESPONSIBLE PARTY’S NAME, TITLE & PHONE NUMBER

SECTION II: ORGANIZATION

Type of Organization (please check):

Individual ------------------------------------------------------------------ [ ]

Partnership ----------------------------------------------------------------- [ ]

Corporation ----------------------------------------------------------------- [ ]

Other (please specify)______________________________________________

If a Corporation:

Attach Articles of Incorporation and,

If nonresident corporation, attach copy of Certification of Good Standing issued by the

South Carolina Secretary of State’s office which indicates corporation’s authority to do

business in South Carolina.

SECTION III: FINANCIAL

Provide a statement, which describes the general financial status of the applicant (current

assets, liabilities & etc.) Attach to application.

Payphone Service Provider (Psp) Application For Certification - Public Service Commission Of South Carolina