Company Contact Name
Enter the company contact name for questions and communications at the company. This
is not the Agent contact.
Telephone Number
Enter telephone number for the company contact for questions and communications. This
is not the Agent phone number.
Company Contact Email Address
Enter the company contact email address for questions and communications. This is not
the Agent email address.
Line 6 - Primary Communications Business
Place an “X” in the box to the left of the code that best describes the principal
communications activity.
CLEC - Competitive Local Exchange Carrier that is not a total resale provider
CLEC (TRS ONLY)– Competitive Local Exchange Carrier that is a total
resale provider
ILEC - Incumbent Local Exchange Carrier - provider of franchised local
exchange service
WIRELESS - Telephone, Wireless PCS and Mobile Radio Service providers
OTHER - Check other if none of the above categories describes the company.
Please explain as indicated. (e.g. Electronic Tax Service Preparation, Fax
Service)
Line 7a - Parent Company
Enter the name of the parent, holding company or controlling company, if any.
Complete Mailing Address
Enter the complete mailing address of the parent, holding company or controlling
company including street address, city, state, zip, suite numbers, floor, etc. Please do not
list only a P.O. Box number. This is not agent information.
Parent Company Contact Name
Enter the company contact name at the parent company. This is not agent
information.
Telephone Number
Enter telephone number for the parent, holding company or controlling company
headquarters. This is not agent information.
Parent Contact Email Address
Enter the parent company contact email address. This is not agent information.
October 2009
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