Local Service Request

Your request will not be processed unless information is entered into each required field.

Note: The area code is required for each entered telephone number, but that the "1-" prefix is not. All telephone numbers must be numeric. Anything other than numeric (for example: letters, special characters, etc.) will not be accepted.

LSR Forms

(select the type of service and simple port options below to initialize the form)

Type of Service (ServiceCenter) (Required) Business (7125) Business (7421)
To Gaining LSP: Important Warning for ADL (AT&T Digital Link) SPID 7421 customer's ONLY. If the Customer has DIDs (Direct Inward Dial) provisioned on the AT&T SDN (Software Defined Network) as On-Net: No changes should be made to the Long Distance ARS (Automatic Route Selection) pattern associated with the SDN (Software Defined Network) Features without an order request to the customer's AT&T Account Team.

Simple Port?(Required)
No Yes

a) Does not involve unbundled network elements; b) it is an existing local account only for a single line; c) does not include complex switch translations (e.g., Centrex, ISDN, AIN services, remote call forwarding, or multiple services on the loop); and d) does not involve resold services.

Administrative Information

Refer to the Form Instructions page for detailed information on how to complete the form.

PON (Required)

ATN
(Required)

CCNA
(Required)

CC
(Required)

NNSP
(Required)

LSP Name
(Required)

NPDI
(Required)

Supplemental Request?
No Yes

SUP

VER

Service Center 7125 requires a 4 day lead time. Any request submitted after 3:00 PM MT with a DDD of three days or less in the future must be expedited. To submit an expedited request, you must select Y in the EXP field, and enter Expedite Remarks.

DDD (Required)


Month	Day	Year

EXP

EXP Remarks

Optional for Service Center 7421 Only
CHC	DDD - Time		DFDT
	:		:
	Hour : Min	Time Zone	Hour : Min

REQTYP
(Required)
CB

ACT
(Required)
V

MI
(Required)

RPON

RORD

AGAUTH (Required)
Yes

DATED


Month	Day	Year

AUTHNM

Contact Section

INIT (Required)

TEL NO (Required)

EMAIL (Required)

FAX NO

Customer Location and Access

NAME (Required)

AFT

SAPR

SANO

SASF

SASD

SASN (Required)

SATH

SASS

LD1

LV1

LD2

LV2

LD3

LV3

CITY (Required)

STATE (Required)

ZIP (Required)

LCON

TEL NO

EUMI

Service Details Section

NPQTY

All Ported Numbers must be Local Routing Numbers (NPT=D). For Service Center 7125, the Ten Digit Trigger (TDT) will be activated. For more information, click on Help.

PORTED NBR 1 (Required)	RANGE 1
-

PORTED NBR 2	RANGE 2
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PORTED NBR 3	RANGE 3
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PORTED NBR 4	RANGE 4
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PORTED NBR 5	RANGE 5
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PORTED NBR 6	RANGE 6
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PORTED NBR 7	RANGE 7
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PORTED NBR 8	RANGE 8
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PORTED NBR 9	RANGE 9
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PORTED NBR 10	RANGE 10
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PORTED NBR 11	RANGE 11
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PORTED NBR 12	RANGE 12
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PORTED NBR 13	RANGE 13
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PORTED NBR 14	RANGE 14
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PORTED NBR 15	RANGE 15
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PORTED NBR 16	RANGE 16
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PORTED NBR 17	RANGE 17
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PORTED NBR 18	RANGE 18
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PORTED NBR 19	RANGE 19
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PORTED NBR 20	RANGE 20
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PORTED NBR 21	RANGE 21
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PORTED NBR 22	RANGE 22
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PORTED NBR 23	RANGE 23
-

PORTED NBR 24	RANGE 24
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PORTED NBR 25	RANGE 25
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PORTED NBR 26	RANGE 26
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PORTED NBR 27	RANGE 27
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PORTED NBR 28	RANGE 28
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PORTED NBR 29	RANGE 29
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PORTED NBR 30	RANGE 30
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PORTED NBR 31	RANGE 31
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PORTED NBR 32	RANGE 32
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PORTED NBR 33	RANGE 33
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PORTED NBR 34	RANGE 34
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PORTED NBR 35	RANGE 35
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PORTED NBR 36	RANGE 36
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PORTED NBR 37	RANGE 37
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PORTED NBR 38	RANGE 38
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PORTED NBR 39	RANGE 39
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PORTED NBR 40	RANGE 40
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PORTED NBR 41	RANGE 41
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PORTED NBR 42	RANGE 42
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PORTED NBR 43	RANGE 43
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PORTED NBR 44	RANGE 44
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PORTED NBR 45	RANGE 45
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PORTED NBR 46	RANGE 46
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PORTED NBR 47	RANGE 47
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PORTED NBR 48	RANGE 48
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PORTED NBR 49	RANGE 49
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PORTED NBR 50	RANGE 50
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PORTED NBR 51	RANGE 51
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PORTED NBR 52	RANGE 52
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PORTED NBR 53	RANGE 53
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PORTED NBR 54	RANGE 54
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PORTED NBR 55	RANGE 55
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PORTED NBR 56	RANGE 56
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PORTED NBR 57	RANGE 57
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PORTED NBR 58	RANGE 58
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PORTED NBR 59	RANGE 59
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PORTED NBR 60	RANGE 60
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PORTED NBR 61	RANGE 61
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PORTED NBR 62	RANGE 62
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PORTED NBR 63	RANGE 63
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PORTED NBR 64	RANGE 64
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PORTED NBR 65	RANGE 65
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PORTED NBR 66	RANGE 66
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PORTED NBR 67	RANGE 67
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PORTED NBR 68	RANGE 68
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PORTED NBR 69	RANGE 69
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PORTED NBR 70	RANGE 70
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PORTED NBR 71	RANGE 71
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PORTED NBR 72	RANGE 72
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PORTED NBR 73	RANGE 73
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PORTED NBR 74	RANGE 74
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PORTED NBR 75	RANGE 75
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PORTED NBR 76	RANGE 76
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PORTED NBR 77	RANGE 77
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PORTED NBR 78	RANGE 78
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PORTED NBR 79	RANGE 79
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PORTED NBR 80	RANGE 80
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PORTED NBR 81	RANGE 81
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PORTED NBR 82	RANGE 82
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PORTED NBR 83	RANGE 83
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PORTED NBR 84	RANGE 84
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PORTED NBR 85	RANGE 85
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PORTED NBR 86	RANGE 86
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PORTED NBR 87	RANGE 87
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PORTED NBR 88	RANGE 88
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PORTED NBR 89	RANGE 89
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PORTED NBR 90	RANGE 90
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PORTED NBR 91	RANGE 91
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PORTED NBR 92	RANGE 92
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PORTED NBR 93	RANGE 93
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PORTED NBR 94	RANGE 94
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PORTED NBR 95	RANGE 95
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PORTED NBR 96	RANGE 96
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PORTED NBR 97	RANGE 97
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PORTED NBR 98	RANGE 98
-

PORTED NBR 99	RANGE 99
-

REMARKS


Click the Print button prior to Submit if you want to keep a copy of your completed form.