Port Order Received

Vartel Number Port Form
Subject* :
Vendor requesting LNP * :
Reported By * :
Email * :
Phone * :	example 16785551234
Customer type :
Current carrier * :
Foc Date * :	MM/dd/yyyy
Billing Telephone Number * :	example 16785551234
Port this BTN * :
Customer name * :
LOA authorizing persons name * :
Is this a wireless port :
Service account number :
Service pin number :
Service Address * :
Service address 2 :
Service city * :
Service state * :
Service zip * :
Numbers to port * :
Additional notes :

Port Order