Telecommunications Response Form

Disaster Recover Plan In place

Yes

No

Operator Service Provider:

Local Service Provider:

AT&T

Verizon

Citizens

MCI

Other Please list below

Other Please list below

Vendor

Vendor

Long Distance Provider:

Internet Provider:

AT&T

AT&T

ACC

UUNET

Other Please list below

Other Please list below

Vendor

Vendor

Patient TV / Telephone Service

Telehealth

UTC

TMS

TV Rental

Vendor

Other Please list

Type of PBX

Years Old

Last Upgrade

Switch Vendor / Switch Maintenance

Comments:

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Contact

Address:

City:

State/Prov:

Zip/Post. code:

Fax

Phone:

E-mail:

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To contact us:

Dave  Bull  518-355-4510 / 800-266-2855 
Mary Ryan  518-355-7648  / 877-355-7645       
Fax:  518-355-7621
Email: DaveBull@bullcommunicationsinc.com
          MaryRyan@bullcommunicationsinc.com