CLLI Code Request Form

* denotes required field

NTCA Member or Affiliate of NTCA Member? *   Yes   No

(If Affiliate, NTCA Member Name)

 

1.

Requester Information
 
 

Date: * 

Requested By: * 

Company Name: * 

Mailing Address: * 

Operating Company # (OCN): * 

Telephone: *   Fax: * 

E-mail Address: * 
 

2.

General Information
 
  This request is for (check one):*
 New Code   Update Code   Delete Code

Existing CLLI Code (For Update/Delete requests only)

Reason for Update (required for Update request):
 

3.

Site Information
 
  (NOTE: you must provide either a full address or an alternate description)

Street Address (Include Floor, Room or Suite #):

City/Town/Municipality:

State:   Zip Code:

If the Location does not have a Street Address, please provide an alternate description, i.e., the nearest street intersection (on Hwy X, 12 mi S of intersection with King Road):

Does a CLLI already exist at this address? *   Yes   No

If yes, what is the existing CLLI? 


Geographic Information:

Latitude

Longitude

or

V

H


Function performed at Location — Entity Type (Example: Host, Remote, Tandem):*

CLLI of "Host" if this a REMOTE Office: (if "Remote" entered above)

Vendor Name: * 

Equipment Type: * 

 
  If you have any questions about this form, please call Karen Hoffman at 301-459-7590, or e-mail khoffman@jsitel.com. If you prefer not to submit your request online, you may download this form and fax it to 240-556-1399 (attn: Ms. Karen A. Hoffman). You should receive an email confirmation of your request within the next 24 hours. If you do not receive an e-mail confirmation, please contact Karen Hoffman at 301-459-7590.