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 |
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 |
24 Hour x 7 Day Telephone Number Access number for Safety Agencies to contact switching carrier –– 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 |
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 –– Admin Contact Fax Number –– 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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