Attachment 1, Worksheet #1
South Carolina Universal Service Fund Contribution Worksheet
Contributor Indentification Information:
101 Legal name of reporting Entitiy:____________________________________________
102 IRS employer identification number:______________________________________
103 Name telecommunications service provider is doing business as if different than shown
above:__________________________________________________________
104 Complete mailing address of reporting
entity:_____________________________________________________________________
__________________________________________________________________________
__________________________________________________________________
105 Individual who completed these worksheets:____________________________________
106 Telephone number of individual completing these worksheets:_______________________
107 Fax number of individual completing these worksheets:____________________________
108 Address where Universal Service Fund bills should be sent:________________________
________________________________________________________________________
________________________________________________________________________
109 Contact person at your Company for Universal Service Fund billing
questions:______________________________________________________
110 Contact person's (in 109 above) telephone number:____________________________