Telegration, Inc. - Special Pricing Request Form

LD SPAR Form

This whole form has to be filled out to be able to submit. Put zeroes in the fields that don't apply. To qualify for SPAR pricing, usage must be at least $200, or businesses without all AT&T/Midwest or Verizon/Midwest lines, or an AT&T Contract for at least $1000, or LD with a Full Line Winback, or Dedicated services.

* indicates required field
Account Executive Information:
*First Name:	* Mandatory Field	*Date:	* Mandatory Field *
*Last Name:	* Mandatory Field
*Email:	* Mandatory Field Invalid Email Format
Sales Manager:

Business Information:
*Business Name:	* Mandatory Field	Contact Name:
*Address:	* Mandatory Field	Contact Number:
*City:	* Mandatory Field
*State:
*Zip:	* Mandatory Field
Current Customer:
Original Sign Date:	Please enter a valid date.	Expiration Date:	Please enter a valid date.
*BTN:	* Mandatory Field	Location:
*LEC(s):	* Mandatory Field	Flat Rate Request:
Any other information or request:
Authorized Signer:		Authorized Signer Title:
Authorized Signer's Email :

Account Information:

TGN Client Profile Form Started?
If yes, fax to VP @ 248-458-2504

Proposal Completion Date:

*
Please enter a valid date.

Proposal Submission
Date to VP:

Please enter a valid date.

Other Sales Opportunities (FLWB,Data,Internet)

Outbound 1+	*In-State	*Inter-State
Minutes (list dedicated/switched):	* Mandatory Field Please enter a numeric value	* Mandatory Field Please enter a numeric value
Inbound Toll Free	*In-State	*Inter-State
Minutes (list dedicated/switched):	* Mandatory Field Please enter a numeric value	* Mandatory Field Please enter a numeric value


(Remember this is only for minutes used multiplied by rate - not taxes, fees, info calls, etc.)
Estimated Gross Commission:
Additional Contract Info:
Upload Documents:	You may add multiple files to your submission. Simply choose them one at a time using the Upload Documents field below.