Select:
New CID
Update to existing CID |
| Company Identifier (5 characters Alpha/Numeric – minimum 3 characters) |
| Physical Address:
Company Name
Street Address
Street Address 2
City
State
Zip Code
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| Invoicing/Mailing Address (If different from above address):
Company Name
Address
Address 2
City
State Zip Code |
Invoicing/Billing Contact Name
Invoicing/Billing Contact Telephone Number
Invoicing/Billing Email
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24 Hour x 7 Day Telephone Number
Access number for Safety Agencies to contact switching carrier
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Area Supported by service 2-character state names, or other
Type of Local Service (Please select all that apply. Press and hold CTRL key for multiple selections.)
If other, please identify:
# of Access Lines/Subscribers
OCNs Completed only by dial tone providers; NOT PS911 or VoIP
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| Administrative Contact Information
This is a non-emergency contact for the CID database content. This person is responsible for accuracy and at a minimum check and verify content quarterly.
Admin Contact Name
Admin Contact Title
Admin Contact Telephone Number
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Admin Contact Fax Number
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Admin Contact Email Address:
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| Submitter Contact Information
Submitter’s Name:
Submitter’s Title
Submitter’s Telephone Number
Submitter’s Email: (Your Email)
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Comments:
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