Nobel Ltd.

Company

Carrier Inter-Connection Form

Type of Contract

Reciprocal

Nobel Buyer

Nobel Seller

General Information
Company Name

Country

Address

Main Telephone

City

Main Fax

Postal code

URL

State/Province

Other

Business Information
General Purpose

US Inbound

US Outbound

International IN

WS

Retail

WS & RT

International OUT
Organic

ITFS

Type of traffic
Tier

Tier 1

National/Regional

Wholesaler

Partner Direct

Retailer

Capacity

Small

Medium

Large

Minutes per month

Directs (destinations)
Employee number
Yearly revenues
Billing time zone

PST

CST

EST

GMT

Payment Terms IN

OTHER :

Payment Terms OUT

Banking Information

Bank References

Payment to:

Bank (Branch) Name

Bank

Address

Address

Bank Officer

Attn:

Phone

Phone #

E-mail

ABA Routing #

Fax:

Account#

ACCT#

Carrier/Trade References
Company 1

Company 2

Company name
Address
Type of business
Contact Person
Phone
E-Mail
Fax

Contact Information
AM (buyer)

Sales Manager

High end escalation(CEO) Billing Contact

Tech Contact

Contact name
Title
Phone
Fax
E-Mail
Cell
IM
Seller (if different)

Technical Information
Capacity IN

Capacity OUT

IP address

Prefix# IN

Prefix# OUT

Signalling

VoIP

If TDM: Carrier ID IN

Carrier ID OUT

Interconnection

Location

Connection Fee

Testing Info
Has Signaling Protocol to Return Calls That are Not Completed Y\N

Additional Comments (OFFICIAL USE ONLY)

Confidential

12/12/2014

Page 1

Nobel Ltd. Company

Submitted by:

_____________________
Please sign

Date:

Confidential

12/12/2014

Page 2

Important info from retail costumers

Operations' location
Pops (potential breakouts) within country
Services in various locations
B2B and/or Consumer
Breakouts available
Peak/Offpeak available
Source of retail traffic
Swap partners
Part of multinational company