The Connection Information Form provides MOREnet with necessary information about your organization's network and assists in determining the proper connection and equipment configuration. Incomplete or inaccurate information may affect the service delivery time, as well as performance of the provided service. Contact MOREnet if you have questions about completing this form.

Depending on the type of connection being installed, the organization may be responsible for some or all of the installation costs. If applicable, MOREnet will inform the organization prior to ordering the connection.

* Indicates a required field.

Request Information

Requested By


*

Requested Service

*Check all that apply:
)


Note: Installation times can vary widely and are dependent upon factors such as site location, provider and circuit capacity. For more information regarding installation times, please contact the appropriate MOREnet Program Manager.
Installation Information

Installation Contact

*
*  

Installation Location

*
* (Please do not list a P.O. Box)
*   *    *
* (Phone must be in installation building.)
Telephone Company Demarcation Point
(Location of the phone equipment.)
*   *
Connection Demarcation Point
(Location for your current or proposed router.)
*   *
*Is this the same location as your current connection?  

Note: Many service providers will install the connection only where other telecommunication services are already located in the building. If the requested demarcation point is located other than the room where your telephone equipment is located, extended demarcation wiring may be needed and may result in additional costs to the organization. Please contact MOREnet if you are unsure of the demarcation point placement.

Network Information

Note: Ethernet is used to connect organization’s network to the router.

*

*Will this connection be used for IP video services?
   

For questions or comments about this form, please contact MOREnet and ask for Connie Smith.

If you would prefer to submit a paper form, please print the completed form and send to the attention of Connie Smith at:

Mail: MOREnet, 3212 LeMone Industrial Blvd., Columbia, MO 65201
Or Fax: (573) 884-6673