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Service Provider Information

Service Provider Information

Entity Type Individual Person Corporation Limited Liability Company (LLC) Partnership Sole Proprietorship Trust Non-Profit Organization Government Entity

Select the type of entity

Full Legal Name

As it should appear on the document

Doing Business As (DBA)

Optional trade name

State of Formation Select state... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia

Where the entity was formed

Authorized Representative

Person authorized to sign

Representative Title

Title or position

Address

Street Address

Full street address including suite or unit number.

City

City of service provider residence or business.

State Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia

State where this address is located.

ZIP Code

5-digit ZIP code.

Email Address

Used for correspondence and notices.

Phone Number

Best number for direct contact.

Client / Subscriber Information

Client Information

Entity Type Individual Person Corporation Limited Liability Company (LLC) Partnership Sole Proprietorship Trust Non-Profit Organization Government Entity

Select the type of entity

Full Legal Name

As it should appear on the document

Doing Business As (DBA)

Optional trade name

State of Formation Select state... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia

Where the entity was formed

Authorized Representative

Person authorized to sign

Representative Title

Title or position

Address

Street Address

Full street address including suite or unit number.

City

City of client residence or business.

State Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia

State where this address is located.

ZIP Code

5-digit ZIP code.

Email Address

Used for correspondence and notices.

Phone Number

Best number for direct contact.

Service Terms

Services to Be Provided *

Specify bandwidth, voice channels, and any managed services. Include specific circuit IDs or service delivery addresses for each location.

Monthly Service Fee ($) *

The recurring monthly charge for all services listed. Specify whether this includes equipment rental, installation, or taxes/regulatory fees.

Contract Term * Month-to-Month 1 Year 2 Years 3 Years 5 Years

Longer terms typically come with lower rates. 3-year terms are common for dedicated fiber circuits. Month-to-month provides flexibility but at a higher rate.

Uptime / Availability SLA (%)

99.9% uptime = 8.7 hours of downtime/year. 99.99% = 52 minutes/year. Mission-critical applications may require 99.99% or better with redundant circuits.

Early Termination Fee

Telecom providers often require payment of all remaining contract months upon early termination. Negotiate this carefully for long-term contracts.

SLA Credit for Outages Pro-rated daily credit for each hour of downtime Fixed credit per outage incident No SLA credits (best-effort service)

SLA credits compensate for downtime but rarely cover actual business losses. For critical applications, require redundant circuits rather than relying solely on SLA credits.

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Not Legal Advice: This automated form assistance tool provides general information and document templates. It is not a substitute for legal advice from a qualified attorney. Laws vary by jurisdiction and change over time. Consult with a licensed attorney for advice specific to your situation.
Last updated: January 2026