Proposed Preform – OLNW Webforms

Preform

Internal Notes
This section is Serina's Notes in designing this form.
- Current Form Stage: Planning Only
- Notifications & Confirmation pages not currently accessible as submission button is currently disabled from view (We will test those functions in the next design phase)
- Orange font on the form are my highlighted questions about specific fields and will be removed in a finalized version

Use the following field to control what would be presented to customers in which instances.

Service Type {HIDDEN Field}(Required)

DATA only

VOICE only

DATA & VOICE services

Note: this field will be HIDDEN but will be auto populated by the link that the sales person gives the customer. This will designate which sections show by default.
We can talk about if we want this selectable by the customer.

Hunter Communications Pre-form

Account Type(Required)

Residential

Business

Is this form to be filled out by residential customers? Is there a reason to ask this question?? IF only being used by buisness, maybe other option should really be "Residential - but billed to a business account" or something like that? Let me know what information we are actually trying to note from their selection.

Business Name(Required)

Legal Entity Name of Company

Business Main Phone Number:(Required)

Physical Service Address(Required)

Street Address City State ZIP Code

Billing Address(Required)

Same as above

Street Address City State ZIP Code

Preferred Billing Method(Required)

Email Billing

Paper Billing (Note: Mailed bills - monthly processing fee applies)

How would you like to receive your monthly bills?

Account Billing Email(Required)

Email address that receives monthly billing

Authorized Account Contacts (CPNI)

Only the following listed Authorized Representatives will be able to access proprietary account information and may be authorized to make changes on the account.

Primary Account Contact Name(Required)

First Last

Primary Contact Email(Required)

Primary Contact Phone(Required)

OPTION: Authorize other specialized account contacts (select all that apply)

Billing Contacts

Technical Contacts

Other Representative Contacts

Emergency Contact (other than Primary)

External Contact - IT Vendor

Designate any other contacts you wish to have the authority to request account specific information, assist with service issues, or make changes on your account.
If there is more than one of any contact type that you would like to designate, click the (+) to add another entry in the list

Notes:
- Primary contact already has authorization over all of these roles so does not need to be added again
- External Vendor IT contacts will only be allowed to assist with cutovers and implementation needs and service issue resolution.

Billing Contacts(Required)

Name

Phone

Technical Contacts(Required)

Name

Phone

Other Representative Contacts(Required)

Name

Phone

Emergency Contacts

Name

Phone

External Authorized IT Vendor Contacts(Required)

Vendor Name

Contact Name

Phone

External IT Vendor contact that will assist in your initial cutover and/or overall maintenance.

CPNI Agreement
I the undersigned officer of the Company, Hereby certify that the individuals listed above have have the authority to request and obtain billing/account information from Hunter Communications in accordance with FCC CPNI disclosure regulations. I also authorize these individuals to make changes to the account and/or services provided under the account and understand that the company will be responsible for any requested changes that impact billable services. I understand that the individuals listed herein are the only contacts with whom Hunter has legal grounds to share billing and account information with and that it is the Customer's responsibility to keep this information as up to date as possible.

Agreement(Required)

I have read, understand and agree to the above statements.

DATA: Wireless & Network needs

Onsite Router needs(Required)

Hunter Communications to provide a router

Existing customer owned router (Router is not owned by existing current provider)

Dedicated IP Needs(Required)

Static IP

DHCP

By default, you will be set up using DHCP unless specified here.

Qty of Static IP's needed(Required)

Please enter a number from 1 to 999.

Wireless Network Coverage Expansion (additional costs will apply)(Required)

Network Expansion NOT currently requested.

Network Expansion of Same Building - wireless coverage needed to room(s) that fall outside of normal wireless range

Network Expansion of Multiple Building / Outside Area(s) that fall outside of normal wireless range

Depending on the type of equipment used to expand coverage of your network, additional costs will vary.

VOICE: Telephone Numbers & Directory Listing Options

Desired Telephone number use(Required)

Assign NEW Telephone Number(s)

Use our EXISTING Telephone Number(s)

Use both EXISTING Telephone Numbers & Assign NEW Telephone Number(s)

You have indicated that you would like to use existing telephone numbers that are currently with a different provider.
In order for Hunter to obtain these numbers to use with your intended service, we will need you to provide a "Letter of Authorization" (LOA) giving us permission to request these phone numbers be transferred to us.
After submitting this form, you will automatically be redirected to the LOA webform. If you need more time to obtain your current provider's account information, the LOA link will also be sent to the email you designated as your Primary Contact email in the CPNI section of this form. Do note that a delay in submitting this information will impact your order timeline.

Preferred Caller ID (CNAME)(Required)

Directory Listing Selection (White pages)(Required)

Simple Directory Listing - Included

Non-listed / Non-published - $0

Additional White page listing (Name & Number) $7.50 each

Additional Listing Quantity

Please enter a number less than or equal to 10.

E911 Selections & Required Notifications

E911 Address(Required)

Same as Physical Service Address given above

Street Address City State ZIP Code

OPTIONAL: Additional E911 Dispatch Notes about site: (30 characters max)

E911 Address Notifications
You have authorized Hunter Communications to furnish the above designated information to emergency staff for reference in the event of an actual "911" emergency. Hunter Communications is not liable for incorrect information supplied by the client. Un-provisioned 911 Call: A call to emergency service with a non-provisioned number is liable for a $250.00 one-time charge

Required E911 Notifications
Important Notice Regarding VoIP & E911 Service. Hunter Communications offers phone services provided via Voice over Internet Protocol (“VoIP Services” or “Services”) and traditional analog phone Services. Rules require that providers of VoIP Services notify customers subscribing to said Services of the following:
(i) Hunter Communications requires a true and accurate service site address in order to deliver accurate location information to E911.
(ii) if customer moves VoIP Services equipment to a different physical address, Hunter representatives must be notified immediately in order to update the location information and ensure that E911 records include true and accurate location information.
(iii) VoIP Services operate using standard electrical power provided to the service site. Consequently, the Services will be unavailable during a power outage unless the customer has arranged for adequate back-up power supply.
(iv) Customers may not be able to make E911 calls if there is a power outage, network outage or other service disrupting technical problem, or if your Hunter provided VoIP Service is terminated or suspended for any reason.

E911 Notification Agreements(Required)
I have read, understand, and agree to the above E911 notifications

Customer Agreement

Validation and Confirmation Statements(Required)
I confirm that I am over the age of 18; that that I am authorized to provide this information on behalf of the entity that services are being ordered for; and that the information I have provided is accurate and correct to the best of my knowledge.

Signature

Printed Name
First Last

Date(Required)
MM slash DD slash YYYY