Disconnect Request - Fiberlight Fiberlight

Requester Full Name(Required)

Today's Date

FBL Customer Company Name(Required)

Enter your Company Name requesting this Disconnect (Should be the Fiberlight contractual Company Name, not your end user name).

FBL Customer Phone(Required)

Enter your Customer Phone # that is requesting this Disconnect.

Customer POC(Required)

Customer Email(Required)

Enter the email address that will receive confirmation of this Disconnect request with a ticket number to reference. Should be the contractual customer email, not the customer's end user email)

Requested Disconnect Date(Required)

Service Type(Required)

Circuit ID(Required)

Enter Lit or Dark Circuit ID Info - One circuit per Submission

Order Number(Required)

Enter the Order Number on your contract. 6 digit OPP-xxxxxx or ORD-xxxxxx. If unknown, enter Unknown.

Contract Number(Required)

Enter the Order Number on your contract. 6 digit MSA, IRU, etc. with related digits or name. If unknown, enter Unknown.

BAN (Billing Account Number)(Required)

Found on your invoice

Monthly Service Charge(Required)

Non-Recurring Charges

Additional Comments, Instructions or Contact Information(Required)

Description is limited to 350 characters

Upload Your KMZ File (ZIP required)

Accepted file types: zip, Max. file size: 10 MB.

.ZIP REQUIRED (please compress KMZ file in .ZIP format before uploading)

Upload Additional Documents

Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, Max. file size: 10 MB.