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Customer Care Forms
Disconnect Request
Disconnect Request
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)
MM slash DD slash YYYY
Service Type
(Required)
--- Select Service Type ---
Lit
Dark
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.
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First Name
(Required)
Last Name
(Required)
Email
(Required)
Market Location
(Required)
Please Make a Selection
Ashburn, VA
Atlanta, GA
Austin, TX
Baltimore, MD
Beaumont, TX
Boca Raton/West Palm Beach, FL
College Station, TX
Corpus Christie, TX
Culpeper, VA
Dallas/Ft, Worth, TX
Ft. Lauderdale, FL
Herndon, VA
Houston, TX
Laredo, TX
McAllen, TX
Miami, FL
San Antonio, TX
South Florida St. Petersburg, FL
Tampa, FL
Temple, TX
Waco, TX
Washington, DC
Out of Market
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I would like to speak to someone directly
Phone
(Required)
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