NENA Company ID Form - National Emergency Number Association

Type Application: *

Company Identifier Code: *

Limited to 3-5 characters

Company Name: *

Company Address Line 1: *

Company Address Line 2:

Company City: *

Company State: *

Company Zip: *

Billing Company: *

Enter SAME if billing info is the same as the company info entered above and skip to Billing Contact.

Billing Address Line 1:

Billing Address Line 2:

Billing City:

Billing State:

Billing Zip:

Billing Contact Name: *

Billing Contact Phone: *

Billing Contact Email: *

24x7x365 Phone: *

This number will be used by PSAPs to request information when there are problems with 9-1-1 calls from your customers.

Other Local Service (if checked above):

SPID:

Service Provider ID – Wireline providers

Admin Name: *

Admin Title: *

Admin Phone: *

Admin Fax: *

Admin Email: *

Submitted By Name: *

Submitted By Title: *

Submitted by Phone: *

Submitted by Email: *

Number of Access Lines: *

Comments: