LSR Submission Port Order Old Provider: PacificWave Communications - SPID 4697 REQTYPE: CB - Number Portability ACT: V Confirmation will be e-mailed to address provided. Local Service RequestSUP1 - Cancel Request2 - Due Date Change3 - Any Other Changeleave SUP blank if this is the initial orderPON:* DTSENT* Month Day Year Desired Due Date:* MM slash DD slash YYYY New Provider* CC / NNSP / SPID* TOSResidentialBusinessAuthorizationAuthorized Name* First Last Needs to be Authorized Account ContactDate of Authorization* MM slash DD slash YYYY End User InformationName* First Last Business Name* End User Billing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Quantity of numbers being ported Porting Number(s)example formatting: 5034729200; 5034729201-9205Order Initiator InfoINIT Name* First Last Email* order confirmation will be sent to this addressContact Phone*FAXAttachments (optional)LOAMax. file size: 12 MB.Excel LSR FormatMax. file size: 12 MB.
