LD SPAR Form

This whole form has to be filled out to be able to submit. Put zeroes in the fields that don't apply. To qualify for SPAR pricing, usage must be at least $200, or businesses without all AT&T/Midwest or Verizon/Midwest lines, or an AT&T Contract for at least $1000, or LD with a Full Line Winback, or Dedicated services.

* indicates required field
Account Executive Information
*First Name:		*Date:
*Last Name:
*Email:
Sales Manager:

Business Information
*Business Name:		Contact Name:
*Address:		Contact Number:
*City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hamphsire 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
*Zip:
Current Customer:	Yes No
Original Sign Date:		Expiration Date:
BTN:		Location:
LEC(s):		Flat Rate Request:
Any other information or request:
Authorized Signer:		Authorized Signer Title:
Authorized Signer's Email :

Account Information
TGN Client Profile Form Started? If yes, fax to VP @ 248-458-2504		Yes No
*Proposal Completion Date:		Proposal Submission Date to VP:
Other Sales Opportunities (FLWB,Data,Internet)
Outbound 1+ In-State Inter-State Minutes (list dedicated/switched): Inbound Toll Free In-State Inter-State Minutes (list dedicated/switched):
(Remember this is only for minutes used multiplied by rate - not taxes, fees, info calls, etc.) Estimated Gross Commission:                                Additional Contract Info: