Long Distance Service Request .

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Long Distance Service Request
Please fill in the form, save it, and send it as an attachment to [email protected] There is a $30 charge to submit a long distance
service request, whether it is for one, or multiple phones. Please allow seven to ten business days for your new service to be confirmed.
You will be provided with an online account number, username and password.
Administrator information
Department name
Administrator name
Adm phone
Adm email
Centurylink account number if one has previously been assigned:
Activation information
Phone
number
to activate
Name or description of
number (enter an ID to
associate with this number)
Location of service
(building/room number or
floor and area description)
Mail stop
code
Allow
international
calls (Y or N)
Group description
(use if you wish to group several
numbers on one account/invoice)
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