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E-9-1-1 TELEPHONE SERVICE CHARGE RETURN
(For the ILEC, all facilities based CLECs, CMRS, Resellers of CMRS and any other suppliers of telecommunication services capable of accessing the 9-1-1 telephone number)
Period Covered (Quarter-Month/Year): ___________
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Filers Name and Address:
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Type of Filer: ILEC ð CLEC (facilities based) ð CMRS ð CMRS RESELLER ð OTHER ð
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#1. E-9-1-1 Charges billed to service users during period
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#2. E-9-1-1 Charges billed to non-facilities based CLECs
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#3. Gross amount billed for 9-1-1 service charges (Add Lines 1+2)
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#4. Adjustments ( bad debts, etc.) (Attach Detailed Schedule)
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#5. Subtract Line 4 from Line 3
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#6. Multiply Line 5 by 1% (Retained administrative fee)
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#7. Subtract Line 6 from Line 4 (Net amount due)
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á á á á á á á
REMIT THIS AMOUNT
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Preparers Name(Print or Type)
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Signature
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Telephone Number
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Date
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SEND COMPLETED FORM AND YOUR REMITTANCE TO:
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INFORMATION REQUESTS:
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Orleans Parish Communication District
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Attn: Ms. Jeanette Williams
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Tel.: (504) 826-1200
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301 South Broad Street
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Fax: (504) 826-1204
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New Orleans, Louisiana 70119
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Email: [email protected]
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