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Service Order Form       PalmettoNet Order Number To be assigned by Palmettonet     Quote Number     Customer Circuit ID Date of Request (mm/dd/yyyy) Customer Order Number Company Name LEC Circuit ID Customer Name LEC Order Number Address Order Type -- New Change Cancel Disconnect City, State, Zip Requested Due Date (mm/dd/yyyy) Telephone Number Expedite ORDER INFORMATION Service Type -- DS 1 DS 3 OC 3 OC 12 OC 48 Ethernet Other (see remarks) Quantity -- 1 2 3 4 5 10 15 20 25 30 Other (see remarks) Term -- MTM 1 Year 2 Year 3 Year 4 Year 5 Year Other (see remarks) Service Type: DS1 Service Type: DS3 Service Type: OC3         OC12         OC48 DS1 Framing -- ESF SF DS3 Framing -- M 13 Clear Channel True Optical Handoff -- Yes No Concantenated -- Yes No DS1 Line Coding -- B8ZS AMI Muxing to DS1 -- Yes No A Loc - Handoff -- Yes No         Loc Mux -- A Loc Z Loc A Local Loop Z Local Loop Z Loc - Handoff -- Yes No             Route Protected -- Yes No             A Loc - DS3 Handoff         Describe         Z Loc - DS3 Handoff         Describe Ethernet Types -- 10 Mbps 50 Mbps 100 Mbps 250 Mbps 500 Mbps 1000 Mbps Other (see remarks) Handoff -- Electrical Optical Protection Scheme -- Linear Diverse LOCATION A LOCATION Z Street Address   Street Address   City, State, Zip City, State, Zip NPA-NXX NPA-NXX LEC LEC Handing Off To Handing Off To LOCATION A LOCAL LOOP ORDERED BY LOCATION Z LOCAL LOOP ORDERED BY Street Address   Street Address   City, State, Zip City, State, Zip NPA-NXX NPA-NXX LEC LEC Handing Off To Handing Off To Contact Contact Contact Telephone Contact Telephone PRICING INFORMATION / FROM QUOTE Transport MRC Transport NRC Local Loop MRC Local Loop NRC     Expedite Charge CONTACT INFORMATION SALES CONTACT PROVISIONING CONTACT Name Name Telephone Number Telephone Number Cell Phone Cell Phone Fax Fax Email Email TECHNICAL CONTACT BILLING INFORMATION Name Company Telephone Number Contact Name Cell Phone Street Address Fax City, State, Zip Email Telephone Number     Fax     Email Remarks / Special Instructions The terms of this Service Order shall be those terms set forth herein unless otherwise provided in a written master service agreement, executed by the parties pertaining to this Service Order, and to that end, all such terms are incorporated into this Service Order by reference. The term of this Service Order shall be as specified above under "Term" (or for one year if no date specified), and shall commence on the specified due date. Payment terms are net 30 days and in the event of cancellation of this circuit (s), prior to the end of the term, purchaser shall pay a cancellation fee of 100% of the charge balance. Based on credit review, a deposit may be required prior to turnup of services. To process this Service Order electronically, please type "signed" in the approval field to indicate acceptance of this service order. CUSTOMER APPROVAL Email Address Note: You will get copy for approval Date (mm/dd/yyyy) Terms & Conditions

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