Local Number Port AuthorizationFracTEL Account Code*Numbers will be transferred to this accountCustomer InformationCustomer Business Name*Customer Business Name as it appears on current invoiceCustomer Address*This should be the service address shown on current providers invoice. Use billing address if it is the same. Street Address 1 Street Address 2 City State State or ProvinceAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Contact InformationAuthorized User*This must be the name of the individual who is authorized by current provider to make changes to account and who will be signing Letter of Agency. First Last Authorized User Title*Contact Email Address* Contact Phone*Telephone Number InformationCurrent Service Provider Name*The name of your current carrier or service provider.Account NumberAccount number should be on your current providers invoice.PINIf your account has a PIN it should be on your current providers invoice.Billing Telephone Number (BTN)*If your account number is the same as one of your telephone numbers, enter it as BTN. Otherwise, enter your main number.Is this a Partial Port?*If you have numbers that will not be porting and will remain active with current provider, select YES.FullPartialIs Billing Telephone Number (BTN) Porting?*If port is partial, and BTN is porting, select YES.NOYESNew Billing Telephone Number (BTN)Select a new BTN if partial port and current BTN is porting. This must be one of the numbers that will remain active with your current provider.Enter VOICE numbers to be transferred below Enter FAX numbers to be transferred below CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
