Carrier Customers Disconnect Form

*Attention: XO Business Services™ Customers, please continue to submit your disconnect service requests as you have been previously doing. This form is specific to XO Carrier Services Customers. Thank you.

Bold Fields Are Required

Customer Account Number

Reason for Disconnect

Customer Name

Contact Name

Contact Phone

Contact Phone Ext.

Contact Email

PON

Install Customer PON

XO Install Order #

Was LOA/CFA Provided?

Disconnect Order Number for LOA/CFA

ETL Portability

Type of Product to Disconnect

ECCKT: If applicable please complete either Circuit ID or TNs/DIDs identifier to disconnect.

Circuit ID 1

Circuit ID 2

Circuit ID 3

TNs/DIDs 1

TNs/DIDs 2

TNs/DIDs 3

Primary Loc

Secondary Loc

Requested Due Date
(Format: mm/dd/yyyy)

Remarks
(limit of 255 characters)