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Splice Request
Date Submitted/Received
FBL Customer Company Name
(Required)
Enter the Contractual Fiberlight Customer Company Name (not the Customer’s end user company)
Requester's Full Name
(Required)
FBL Customer Phone
(Required)
Enter your Phone Number for communication
FBL Customer PO#
If applicable, enter the PO number you’re providing or have provided to FBL
Market
(Required)
Select Your Market
Alabama
Atlanta
Austin
Baltimore
Charlottesville
Dallas/Ft. Worth
El Paso
Houston
Indiana
Louisiana
North Carolina
Northern Virginia
Ohio
Oklahoma
Richmond
San Antonio
South Carolina
South Florida
South Texas
Tampa
Tennessee
Texas Panhandle
Waco
Washington, DC
West Texas
West Virginia
Other
Enter the Market where the work will be done
FBL Customer Email
(Required)
Enter the email address that will receive confirmation of this Splice request with a ticket number to reference.
Additional POCs
Add Email Addresses, separated by commas, for any additional POCs to notify
Contract
(Required)
If known, please enter your FBL Contract number. If not known, please enter unknown
Order Number
(Required)
If known, please enter your FBL Order number. If not known, please enter unknown
Fiber Activity
(Required)
Select Your Fiber Activity
Active with Live Traffic
Dark with no Traffic
Location Description
(Required)
Dark Fiber IDs
If known, enter your Dark Fiber Circuit IDs
Priority
(Required)
Standard
Expedite
Expedite fee may be applicable
Splice Date Request
MM slash DD slash YYYY
Does Customer have existing facilities in requested access point?
(Required)
— Please Make a Selection —
Yes
No
N/A
Access Point Ownership
(Required)
Is the Access Point Customer Owned Fiberlight Owned or 3rd Party Owned?
If No Above, has Access been Approved?
(Required)
— Please Make a Selection —
Yes
No
N/A
Ticket Number for Approved Access
(Required)
FBL OSP PM
If known, please enter the FBL PM name, if not known, enter unknown
Description of Request
(Required)
Provide Details of Splice Request. Splice Matrix will be completed with your OSP PM (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
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