AT&T Only - CMC GROUPS

1 Sales Rep Info

2 Customer information

3 AT&T High Speed Internet

4 AT&T Voice Product

5 Additional Promotions

6 Notes

7 Order Summary

Sales Rep*
First Last
Sales Rep Phone*
Sales Rep Email:*
Sales ManagerEmail:*

Business Name*
Customer Name*
First Last
Address*
Street Address City State ZIP Code
Primary Phone*
Cell Phone
Email*
Tax ID*
If Customer has no TAX ID input "Sole Proprietorship"
File*
-Upload Letter of Agency
-Upload Order Form
-Upload Phone Bill & Internet Bill
Drop files here or

AT&T U-Verse High Speed Internet
- U-Verse
- DSL
U-Verse*
- HCM
- Non-HCM
HCM*
Billing Account # BAN*
Non-HCM*
Billing Account # BAN*
DSL*
AT&T Phone Number*
3 Digit Code*
Total
$0.00

Lines
- POTS
Lines
- VOIP
# of POTS Lines*
# of VOIP Lines*
Line 1 - POTS*
AT&T Phone Number 1*
3 Digit Code*
Porting Phone 1*
AT&T Account Phone Number*
3 Digit Code*
Porting Phone 1*
Line 2 - POTS*
AT&T Phone Number 2*
3 Digit Code*
Porting Phone Number 2*
AT&T Account Phone Number*
3 Digit Code*
Porting Phone Number 2*
Line 3 - POTS*
AT&T Phone Number 3*
3 Digit Code*
Porting Phone Number 3*
AT&T Account Phone Number*
3 Digit Code*
Porting Phone Number 3*
Line 4 - POTS*
AT&T Phone Number 4*
3 Digit Code*
Porting Phone Number 4*
AT&T Account Phone Number*
3 Digit Code*
Porting Phone Number 4*
Line 5 - POTS*
AT&T Phone Number 5*
3 Digit Code*
Porting Phone Number 5*
AT&T Account Phone Number*
3 Digit Code*
Porting Phone Number 5*
Line 6 - POTS*
AT&T Phone Number 6*
3 Digit Code*
Porting Phone Number 6*
AT&T Account Phone Number*
3 Digit Code*
Porting Phone Number 6*
Line 7 - POTS*
Phone Number 7*
3 Digit Code*
Porting Phone Number 7*
AT&T Account Phone Number*
3 Digit Code*
Porting Phone Number 7*
Line 8 - POTS*
AT&T Phone Number 8*
3 Digit Code*
Porting Phone Number 8*
AT&T Account Phone Number*
3 Digit Code*
Porting Phone Number 8*
Line 9 - POTS*
AT&T Phone Number 9*
3 Digit Code*
Porting Phone Number 9*
AT&T Account Phone Number*
3 Digit Code*
Porting Phone Number 9*
Line 10 - POTS*
Phone Number 10*
3 Digit Code*
Porting Phone Number 10*
AT&T Account Phone Number*
3 Digit Code*
Porting Phone Number 10*
Line 1- VOIP*
Ban # 1*
Porting Phone Number 1*
Line 2- VOIP*
Ban # 2*
Porting Phone Number 2*
Line 3- VOIP*
Ban # 3*
Porting Phone Number 3*
Line 4- VOIP*
Ban # 4*
Porting Phone Number 4*
Line 5- VOIP*
Ban # 5*
Porting Phone Number 5*
Line 6- VOIP*
Ban # 6*
Porting Phone Number 6*
Total
$0.00

Additional Promotions
- Free 32in TV
- Gift Cards ($100 New U-verse customers only)

channel
Notes

{all_fields}