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Telecommunications Request Form
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The completion of this form will provide PJM with the information necessary to configure and install the required voice and data communications necessary for you, our new customer, to communicate with PJM. PJM will assume total responsibility for the coordination efforts required to acquire and implement the appropriate telecommunications circuits.
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| * PJM Member requesting connection: |
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| Org ID: |
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| * Client Manager name: |
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| * Customer utilizing connection: |
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| * Customer business address: |
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| * City: |
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| * State: |
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* Zip:
Ex. xxxxx |
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| Customer Business Contact |
| * Name: |
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* Phone:
Ex. xxx-xxx-xxxx |
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| * Email: |
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| Customer Technical Representative |
| * Name: |
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* Phone:
Ex. xxx-xxx-xxxx |
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* Cell number:
Ex. xxx-xxx-xxxx |
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| * Email: |
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