COST PROPOSAL

1200 Mt. Kemble Ave.
3rd Floor
Morristown, New Jersey
07960
888.866.7266
bcntele.com

Oppty ID:

Order Type:

Date:

Quote Exp:

Term Len:

Exist Acct:

Partner Name:

Partner ID:

Partner Rep:

Partner Email:

Partner Phone:

Customer #:

	Customer Information

	Primary Service Address
Customer:
Contact:
Street Address:
City, State, Zip:
Office Phone:
Mobile Phone:
Fax:
Email:

	Additional Locations
	Location:
	Address:
	City,State,Zip:

Proposed Services and Charges

Usage Rates/Monthly Recurring/Non-Recurring Charges

Multiple Service Locations Quoted: Yes No

QTY	Description	Usage Rates	Monthly MRC	Monthly Ext	NRC
		$	$	$	$
		MRC Subtotal	$	NRC Subtotal	$

Notes

Summary
Monthly Recurring	$
Non-Recurring	$
Total	$

The rates and charges reflected above do not include any federal, state or local taxes, fees and assessments, other regulatory charges, or federal or state USF program charges.

The undersigned certifies that he/she is authorized to designate BCN Telecom as the service provider for the Company for the telecommunications services contained in this service proposal. Furthermore, the undersigned acknowledges that he/she must execute certain additional BCN Telecom documents for service order submission purposes. These additional documents shall include, but not be limited to, the Service Term Agreement, Letter of Authorization and Credit Application form.

Signature:

Title:

Print Name:

Date:

Confidential and Proprietary to BCN Telecom.
This proposal is provided to the Entity(s) and Individual(s) listed above only, and may not be disclosed or forwarded to any other party without the express, written consent of BCN Telecom.