Channel Member Number: 10175892
Dealer Phone Number: 713-952-3700
Dealer Contact Name: Bill Garcia
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SBC Phone number for DSL request:
Billed to number:
Customer/business Name:
Service Address:
Room/location:
Community (City---do not abbreviate):
State:
ZIP:
Talked With:
Number of PC’s:
Are there more than 6 phone jacks?
Computer Type (desktop or laptop):
Operating System:
Speed of Service requested:
Dynamic or Static IP’s:
If static how many (total/usable): 8/5 16/10 32/20 64/40 128/80
NIC card needed:
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Pre Qualification number:
Customer Speed approved for:
IPD contacted date:
Order processed date:
Order confirmation number:
Order Due date:
LOA Faxed:
Email Sent to IPD: