Request Type (Select One)
Initial
Change
Change Section
Type of Change (Select One)
Connectivity Configuration and Customer Profile Change
Connectivity Configuration Change Only
Customer LSR Profile Change Only
Billing Address Change Only
Please provide the change details here:
Requestor Information
Requestor Name
Requestor E-mail Address
Requestor Telephone Number
Wholesale Customer Information
Company Legal Name
Doing Business As (DBA) [List All]
Mailing Street Address
City
State
Zip
CCNA
CCNA/ACNA (aka IAC Code) is a three-character alphabetic code.
CIC
The CIC (Carrier Identification Code) provided will be verified in NANPA’s Numbering Resources document. Separate multiple entries with a comma.
Federal Tax Information
Federal Tax ID Number
Is customer claiming Federal Tax Exemption status?
Yes
No
Does customer have a FCC Form 499 Filer ID?
Yes
No
FCC Form 499 Filer ID
Type of Wholesale Connectivity Requested
Access Module for ASR Transactions (Select One)
VFO Online GUI Only
VFO Online GUI Only with Responses via Email to Initiator Email Address (See note below)
UOM Web Service Only - VPN [EP]
UOM Web Service -VPN / With VFO Cross-Visibility [EP]
UOM Web Service Only – Interactive Access over HTTPS [EP]
UOM Web Service – Interactive Access over HTTPS / With VFO Cross-Visibility [EP]
Access Module Changes
Access Module Not Needed or No Changes
Note: If the user does not populate the Initiator Email address on the ASR, no email will be generated.
Access Module Connectivity Comments
Local Module for LSR Transactions (Select One)
VFO Online GUI Only
VFO Online GUI Only with Responses via Email (Additional required fields below)
EDI Only via Interactive Agent – VPN [EP]
EDI via Interactive Agent – VPN / With VFO Cross-Visibility [EP]
EDI Only via Interactive Agent with Dedicated Circuit (Change/Disconnect Only) [EP]
UOM Web Service Only – VPN [EP]
UOM Web Service -VPN / With VFO Cross-Visibility [EP]
UOM Web Service Only – Interactive Access over HTTPS [EP]
UOM Web Service – Interactive Access over HTTPS / With VFO Cross-Visibility [EP]
Local Module Changes
Local Module Not Needed or No Changes
Are Provider Notifications required via E-bonding Option Above?
Yes
No
*Generation of Provider Notifications (aka Line Loss Reports) Requires Registration to Customer Wholesale Portal: https://Wholesale.frontier.com/Wholesale/reports/login/
VFO Responses via Email:
Email Initiator
Email Other (Other Email Required Below)
Note: If selection above is 'Email Initiator', the user must populate the Initiator Email address on the LSR to generate email.
Other Email Address(es)
*If 'Other' is selected, please provide email address or addresses of intended recipients in the Other Email Address box. (Multiple email addresses should be separated by a comma.)
Type of Responses to Email:
Rejects / Errors
Jeopardy
Confirmations (FOC)
Provisioning Completion Notice (PCN)
Billing Completion Notice (BCN)
The LSR Status Email Notification subject line will include the status type and the PON of the impacted Local Service Request (LSR).
Local Module Connectivity Comments
TA Module for Trouble/Maintenance Transactions (Select One):
VFO Online GUI Only
tML Web Service Only - VPN [EP]
tML Web Service - VPN / With VFO Cross-Visibility [EP]
tML Web Service Only – Interactive Access over HTTPS [EP]
tML Web Service – Interactive Access over HTTPS / With VFO Cross-Visibility [EP]
TA Module Changes
TA Module Not Needed or No Changes
TA Module Connectivity Comments
Product Options:
Check all that apply:
LNP only (no directory listings) [CB]
LNP w/ Directory Listings [CB]
Stand Alone Directory Listing Only (no LNP) [JB]
Loop (ACTL required below) [AB, BB]
Resale [EB, KB, LB, NB, PB, QB]
POTS Connect [EB]
Wholesale Advantage Voice [DB]
Wholesale Advantage Voice with Broadband [DB]
Wholesale Standalone Broadband [DB]
Wholesale VoIP [DB]
Access Services (Ethernet, DIA/EIA, Specials, Switched)
Note: if ordering under Resale BAN, established Resale Agreement required.
Connectivity Contacts
Carrier’s Virtual Front Office (VFO) Administrator or Requested VFO Administrator
Name
Email Address
Phone Number
Connectivity Technical Point of Contact
Name
Email Address
Phone Number
Other Contacts
Ordering Contact
Name
Email Address
Phone Number
Is your Escalation Contact information the same as your Ordering Contact information provided above?
Yes
No
Escalation Contact
Name
Email Address
Phone Number
Is your Provisioning Contact information the same as your Ordering Contact information provided above?
Yes
No
Provisioning Contact
Name
Email Address
Phone Number
Is your SAG/911 Contact information the same as your Ordering Contact information provided above?
Yes
No
Street Address Guide (SAG)/911 Contact Information
Name
Email Address
Phone Number
Is your Maintenance/Repair Contact information the same as your Ordering Contact information provided above?
Yes
No
Maintenance/Repair Contact Information
Name
Email Address
Phone Number
State Specific Information
Type
Please select...
State Specific Information
State Code
Please select...
AL
AZ
CA
CT
FL
GA
IA
IL
IN
MI
MN
MS
NC
NE
NM
NV
NY
OH
PA
SC
TN
TX
UT
WI
WV
Is customer claiming State Tax Exemption status?
Yes
No
State Tax ID
Operating Company Number (OCN)
Service Provider Identification Number (SPID)
Access Carrier Termination Location (ACTL) from Collocation Agreement
Billing Information
Bill Remittance Address
Company Legal Name
Department/ATTN:
Street Address
City
State
Please select...
AL
AZ
CA
CT
FL
GA
IA
IL
IN
MI
MN
MS
NC
NE
NM
NV
NY
OH
PA
SC
TN
TX
UT
WI
WV
Zip
Billing Contact Information
Name
Email Address
Phone Number
Bill Media Options
Select all that apply:
Frontier Self-Service Tools (CABS Bill Portal, COBRA Portal)
BDT (Electronic Billing Feed)
Selecting BDT as a Bill Media Option requires a Billing Feed Connectivity Form submission.
Please access form at: https://wholesale.frontier.com/Forms/Billing-Feed-Connectivity-Form.
Frontier Self-Service Tools information is available at: https://wholesale.frontier.com/billing/Online-Billing-Statement-Tools
Tax Exemption Contact Information
Name
Email Address
Phone Number
If the new wholesale billing account numbers are to be coded “exempt” from any applicable taxes and surcharges, certificate of exemption from the Federal Excise Tax and all other appropriate forms indicating exemption from state/local taxes must be provided.
All Tax Exemption Forms and any additional tax exemption information must be submitted via email to: wholesale.tax.exemption@ftr.com.