Company Name

Account Number

Requester First Name

Requester Last Name

Email

Phone Number

Purchase Order Number/Internal Tracking Number

Circuit ID or Legacy Circuit ID

Requested Disconnect Date

Reason for Disconnect Price Service Performance Issues Service No Longer Required Service/Feature Missing

Service No Longer Required Reason Optimization Due to Acquisition End Customer Cancelled Location Eliminated Network Optimization - Grooming

3rd party cross-connect to decommission Yes No I don't Know

Please provide details

Is this being replaced by another service? Yes No

Please provide details

Is There Anything Zayo Needs To Know? Replacement Service 2nd PON/Tracking Number Location Service Component Number Other

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