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<br />
<br />Product Type
<br />
<br />SERVIO; i\'l1J BILLlI\G INFORMATION
<br />
<br />Equipment:
<br />
<br />Security
<br />CuslomerDescription
<br />
<br />BANDWIDTH (mbps)
<br />
<br />PORT
<br />
<br />LOOP
<br />
<br />EQVIPVlENT fila /icuhfl.'j
<br />
<br />CCSTOMER I~FORJ\IATIO'l
<br />
<br />/i/IIf..V(j INF1JH,HAJ'{(),o\'
<br />
<br />Cuslomer Name
<br />
<br />BilliJlg A(hlre,;,
<br />
<br />SlIireFloor
<br />
<br />City/State/fip
<br />
<br />Billing Contact
<br />
<br />Telephone'
<br />
<br />Celll'holl<:
<br />
<br />Fa,'\:
<br />
<br />[-mail'
<br />
<br />C.'ustomel'URL
<br />
<br />45
<br />
<br />45
<br />
<br />....
<br />
<br />of Santa Ana
<br />
<br />20 Civic Center Plaza
<br />
<br />M-12
<br />Santa A.lla. CA 9270 I
<br />
<br />Tom
<br />
<br />7]4-647-6958
<br />
<br />714-647-5406
<br />
<br />~g.~ ~!?~,~<~!:: ~J..~ ~l.l,~.'~ ~~,~.~:.~<1: ,~~'"
<br />www.ci.santa-ana.ca. LIS
<br />
<br />NETWORK SERVICES
<br />CUSTOMER RENEWAL FORM
<br />NORTH AMERICA
<br />
<br />,
<br />.
<br />
<br />Renewal Date
<br />
<br />1-1
<br />
<br />PRICE
<br />
<br />Instaffati,m
<br />(-VJI(')
<br />
<br />N/A
<br />
<br />N/A
<br />
<br />N/A
<br />
<br />N/A
<br />
<br />Custoll1el'!\mne
<br />
<br />ShNU(F..LV/J ()/(/!FR f..vSHI.!,AlJ()/,\,' fNH)HHilllo.,V
<br />
<br /><.1fSanta Ana
<br />
<br />IOI5.,lstStreel
<br />Washinglon,DC10007
<br />ph: 703-456-7916
<br />fax: 703-<)35-8783
<br />IVww,cogentco,com
<br />
<br />5/1/2006
<br />
<br />US3
<br />
<br />CL"""""T i, re;p",,,,oi< ", ",,, """]",,,,, "I' "",,,h 'i"cl"Jil\~ "",,,11"""1\. ""into""",'" ,,"d "II C"''',' OCI<,,,J 111< T!-:I,U) de, ;",' '0 C,,,,,,md., "'Mr or l'lI""me, I~'mi,e 1':~lIip"'e'" (('1'1:, LrLh." ,,'e """" ,hal\ I; "-"<, "I""', or ill a Jilkrcn' ,,,i'" ,hao the rei",
<br />d<IlWTC
<br />
<br />o
<br />
<br />YES'
<br />
<br />DO\'IAI)\' NA:\IE SERVICE Please select <lne 0 lion below
<br />
<br />o
<br />
<br />NO
<br />
<br />RCP SERVICE:
<br />
<br />I)]e~se provide BCiP sCl'vice
<br />
<br />NET\-\-'ORK :\lJ.'\1BER
<br />
<br />~I
<br />_~I
<br />
<br />OldSel>'ice:-JlImber
<br />
<br />OldProduetType
<br />
<br />.'
<br />_.1
<br />
<br />SER\/ICE TERVI
<br />
<br />SIEBEL
<br />
<br />(monrh.\)
<br />
<br />Order .Vumher
<br />
<br />;\Jonth(I' Re,'urring
<br />(AfRCj
<br />
<br />12
<br />
<br />$2,000
<br />$3"200
<br />
<br />12
<br />
<br />
<br />N/A
<br />
<br />N/A
<br />
<br />N/A
<br />
<br />Scrvicc Addre"
<br />
<br />{\lgcnl \Jode
<br />
<br />Suite Floo!
<br />
<br />CityiSIHldZip
<br />
<br />In,fall Contact
<br />
<br />klcphone
<br />
<br />Cell Phone
<br />
<br />Fa.\
<br />
<br />E-mail
<br />
<br />o
<br />
<br />We don'l need domain name serviee
<br />
<br />Please provide domain name service for my already assigned domain name
<br />r,p /(J 10 n"n"',I' fJo,I'led/rec o!charxe
<br />
<br />~I
<br />
<br />YES
<br />
<br />Does this organization need IPaddl'essingfordcstinalionsatt his site') (Pkase select one oplion below.}
<br />o \l0. I am an e\i5ling customo:r and will use my existing II' Addresses
<br />o
<br />o
<br />o
<br />
<br />'0
<br />
<br />1\'0
<br />
<br />
<br />Cuslomer-suppliednetworknllmber
<br />
<br />i\ssignone/29nO:lWOl'knumbcrthatwillsupport6usablo:IPaddl'esses
<br />
<br />Assign moro: than b lI,able IPaddresses Please fill outan IPQ order form
<br />
<br />20 Civic Center Plaza
<br />
<br />[3ascment
<br />
<br />Santa
<br />
<br />CA 9~70]
<br />
<br />Jim Lent/.
<br />
<br />714-647-6909
<br />
<br />714-647-5406
<br />
<br />j I.~~.~?~@_~.i :S.~~,~':l,~,~.~ ~~'.~~'.ll.~.
<br />
<br />(lj.l'umeushiffinxuJdrl:l,l, dil:ckhere)
<br />
<br />'\elW0rk \lask
<br />
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