Wholesale Carrier Interconnect Service Termination Notice
1. Interconnect Service Details
Service Name:
Account Number:
Reference Number:
2. Parties Involved
Carrier Name:
Contact Person:
Phone Number:
Email Address:
3. Termination Request
Requested Termination Date:
Interconnect Service(s) to be Terminated:
Reason for Termination:
4. Affected Circuits/Services
Circuit/Service ID
Location
Additional Information
5. Additional Comments
6. Authorization
Authorized Name:
Signature:
Date: