FORM 408-06 11/94
Date Received:				DISCONTINUANCE
Date to Rep:
Date to Mgr:
CUSTOMER NAME:
11502 MAIN ST
MARTIN
TOWN NUMBER:		CUSTOMER NUMBER:				SYSTEM NUMBER:			JOB NUMBER:
			DISCONTINUANCE TRANSACTION CODE:
EFFECTIVE DATE:			CHECK			13	PARTIAL DISCONTINUANCE
			APPROPRIATE			21	FULL SYSTEM (CONTRACT) DISCONTINUANCE
	CHARGE CONTRACTUAL CTC		BOX			22	FULL CUSTOMER DISCONTINUANCE
	CHARGE NEGOTIATED CTC						DISCONTINUANCE REASON CODE
	CHARGE NO CTC-EXPLAIN
NEGOTIATED CTC AMOUNT:				A-PARTIAL SERVICE DECREASE				I-CANCELLED FOR NONPAYMENT
DISMANTLEMENT CHARGE:				B-CONVERSION				J-DEMOLISHED PREMISES
DISMANTLE:				C-PRICE REDUCTION				K-NEVER EFFECTIVE/NEVER INST
		DATE:		D-OUTRIGHT SALE OF P & E				L-SIO CONSOLIDATION
				E-LOST TO COMPETITION-PRICE				M-BANKRUPTCY-RESALABLE
CURRENT ANNUAL SERVICE CHARGE:				F-LOST TO COMPETITION-SERVICE				N-OUT OF BUSINESS/RESALABLE
				G-RELOCATION/RESALABLE				R-ESCALATION REVERSAL
DISCONTINUANCE AMOUNT:				H-CANCELLED PROTECTION
New annual service charge:
				BILLING SEGMENTS/SYSTEMS TO BE DISCONTINUED
OWNERSHIP	SYSTEM	SERVICE	CONNECTION		TRANSMISSION	OPEN/CLOSE	MAINT/INSP	ASI	MARKET GRP	DISCO AMT
For full system discontinuances fill in the Ownership and System Profile Codes.
For partial discontinuances fill in the Ownership and System Profile Codes, as well as any code that is being changed
(e.g., Eliminating guard service (old code 20) - record the new code (e.g., 10-none) in the appropriate box.)
CONTRACT TERMINATION CHARGE WAIVER COMMENTS:
						GM APPROVAL FOR CTC WAIVER:
REMARKS:
SALES REPRESENTATIVE:							SALES REP		CHARGEBACK %:
							CODE:
NATIONAL ACCT MANAGER NAME:
Area/sales manager:							DATE:
General Manager:							DATE: