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Submitted URL: http://www1.lumen.com/disco/page4.cfm
Effective URL: https://www1.lumen.com/disco/page4.cfm
Submission: On November 18 via api from US — Scanned from US
Effective URL: https://www1.lumen.com/disco/page4.cfm
Submission: On November 18 via api from US — Scanned from US
Form analysis 1 forms found in the DOM
Name: Form — POST page43.cfm
<form method="post" name="Form" action="page43.cfm" enctype="multipart/form-data" onsubmit="return validateForm(this)">
<table width="800" border="0" cellpadding="5" cellspacing="0">
<tbody>
<tr>
<td style="width:500px;">
<span class="label">Case number from your previous Request: </span><span class="redText">*</span> <a href="images/Lumen_TCID.jpg" target="_blank">Click here for Example</a><br>
<span class="redTextSmall">If you do not have your Case Number, please contact: <a href="mailto:Disconnects@lumen.com">disconnects@lumen.com</a></span><br>
</td>
<td style="width:300px;" valign="top"><input type="text" name="case_number" size="35"></td>
</tr>
<tr>
<td><span class="label">Billing Account Number: </span><span class="redText">*</span></td>
<td><input type="text" name="account_number" maxlength="50" size="35"></td>
</tr>
<tr>
<td><span class="label">Billing Account Name: </span><span class="redText">*</span></td>
<td><input type="text" name="account_name" maxlength="50" size="35"></td>
</tr>
<tr>
<td><span class="label">Requestor Name: </span><span class="redText">*</span></td>
<td><input type="text" name="primary_contact_name" maxlength="150" size="35"></td>
</tr>
<tr>
<td><span class="label">Requestor Phone Number: </span><span class="redText">*</span></td>
<td><input type="text" name="primary_contact_phone" maxlength="50" size="35"></td>
</tr>
<tr>
<td>
<span class="label">Requestor Email: </span><span class="redText">*</span><br>
<span class="redTextSmall">Note: If you use an email that differs from your company named email, this could delay processing of this request, due to required verification steps</span><br>
</td>
<td valign="top"><input type="text" name="primary_contact_email" maxlength="150" size="35"></td>
</tr>
<tr>
<td><span class="label">Do you wish Cancel or Extend?: </span><span class="redText">*</span></td>
<td><input type="radio" name="disconnect_type" value="Cancel">Cancel <input type="radio" name="disconnect_type" value="Extend">Extend</td>
</tr>
<tr>
<td><span class="label">All Services or Specific Services?: </span><span class="redText">*</span></td>
<td><input type="radio" name="services_type" value="All" onclick="serviceShowHide(0);">All Services <input type="radio" name="services_type" value="Specific" onclick="serviceShowHide(1);">Specific Services</td>
</tr>
</tbody>
</table>
<table id="tblList" width="800" border="0" cellpadding="5" cellspacing="0" style="margin-top:10px; margin-bottom:10px; display:none;">
<tbody>
<tr>
<td><span class="label">List all Lumen Service ID(s) and/or Telephone Number(s) you wish to Extend or Cancel. If no Service IDs are on your invoice, please tell us the Service Description as it appears on your invoice: </span><span
class="redText">*</span> <a href="images/Lumen_Supporting_Ids.png" target="_blank">Click here for Example</a></td>
</tr>
<tr>
<td>
<table width="100%" border="0" cellpadding="1" cellspacing="0" style="border: 1px solid #841C21;">
<tbody>
<tr>
<td bgcolor="#841C21">
<table width="100%" cellpadding="3" border="0" cellspacing="0">
<tbody>
<tr>
<td>
<input type="button" value="Add Row" onclick="addRow('dataTable')">
<input type="button" value="Delete Row" onclick="deleteRow('dataTable')">
</td>
<td align="right"><input type="button" value="Upload Attachment" onclick="uploadShowHide(1)"></td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td bgcolor="#F0F0F0">
<div style="padding:5px;">
<div style="text-align:center; margin-bottom:5px;">
<span class="redText">IDs, TNs or Descriptions are listed on your invoice. Please limit to 25 or use the Upload Attachment button above for more.</span>
</div>
<table id="dataTable" border="0" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<td></td>
<td valign="bottom">Service IDs,TNs or Descriptions</td>
<td valign="bottom">Service Address</td>
<td valign="bottom">Disconnect Date</td>
</tr>
<tr>
<td align="right">1.</td>
<td><input id="SrvId1" name="SrvId1" size="30" type="text"> </td>
<td><input id="SrvAddr1" name="SrvAddr1" size="30" type="text"> </td>
<td><input id="SrvDate1" name="SrvDate1" size="30" type="text"> </td>
</tr>
<tr style="display:none" "="">
<td align=" right">2.
</td>
<td><input id="SrvId2" name="SrvId2" size="30" type="text"> </td>
<td><input id="SrvAddr2" name="SrvAddr2" size="30" type="text"> </td>
<td><input id="SrvDate2" name="SrvDate2" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">3.</td>
<td><input id="SrvId3" name="SrvId3" size="30" type="text"> </td>
<td><input id="SrvAddr3" name="SrvAddr3" size="30" type="text"> </td>
<td><input id="SrvDate3" name="SrvDate3" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">4.</td>
<td><input id="SrvId4" name="SrvId4" size="30" type="text"> </td>
<td><input id="SrvAddr4" name="SrvAddr4" size="30" type="text"> </td>
<td><input id="SrvDate4" name="SrvDate4" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">5.</td>
<td><input id="SrvId5" name="SrvId5" size="30" type="text"> </td>
<td><input id="SrvAddr5" name="SrvAddr5" size="30" type="text"> </td>
<td><input id="SrvDate5" name="SrvDate5" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">6.</td>
<td><input id="SrvId6" name="SrvId6" size="30" type="text"> </td>
<td><input id="SrvAddr6" name="SrvAddr6" size="30" type="text"> </td>
<td><input id="SrvDate6" name="SrvDate6" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">7.</td>
<td><input id="SrvId7" name="SrvId7" size="30" type="text"> </td>
<td><input id="SrvAddr7" name="SrvAddr7" size="30" type="text"> </td>
<td><input id="SrvDate7" name="SrvDate7" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">8.</td>
<td><input id="SrvId8" name="SrvId8" size="30" type="text"> </td>
<td><input id="SrvAddr8" name="SrvAddr8" size="30" type="text"> </td>
<td><input id="SrvDate8" name="SrvDate8" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">9.</td>
<td><input id="SrvId9" name="SrvId9" size="30" type="text"> </td>
<td><input id="SrvAddr9" name="SrvAddr9" size="30" type="text"> </td>
<td><input id="SrvDate9" name="SrvDate9" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">10.</td>
<td><input id="SrvId10" name="SrvId10" size="30" type="text"> </td>
<td><input id="SrvAddr10" name="SrvAddr10" size="30" type="text"> </td>
<td><input id="SrvDate10" name="SrvDate10" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">11.</td>
<td><input id="SrvId11" name="SrvId11" size="30" type="text"> </td>
<td><input id="SrvAddr11" name="SrvAddr11" size="30" type="text"> </td>
<td><input id="SrvDate11" name="SrvDate11" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">12.</td>
<td><input id="SrvId12" name="SrvId12" size="30" type="text"> </td>
<td><input id="SrvAddr12" name="SrvAddr12" size="30" type="text"> </td>
<td><input id="SrvDate12" name="SrvDate12" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">13.</td>
<td><input id="SrvId13" name="SrvId13" size="30" type="text"> </td>
<td><input id="SrvAddr13" name="SrvAddr13" size="30" type="text"> </td>
<td><input id="SrvDate13" name="SrvDate13" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">14.</td>
<td><input id="SrvId14" name="SrvId14" size="30" type="text"> </td>
<td><input id="SrvAddr14" name="SrvAddr14" size="30" type="text"> </td>
<td><input id="SrvDate14" name="SrvDate14" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">15.</td>
<td><input id="SrvId15" name="SrvId15" size="30" type="text"> </td>
<td><input id="SrvAddr15" name="SrvAddr15" size="30" type="text"> </td>
<td><input id="SrvDate15" name="SrvDate15" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">16.</td>
<td><input id="SrvId16" name="SrvId16" size="30" type="text"> </td>
<td><input id="SrvAddr16" name="SrvAddr16" size="30" type="text"> </td>
<td><input id="SrvDate16" name="SrvDate16" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">17.</td>
<td><input id="SrvId17" name="SrvId17" size="30" type="text"> </td>
<td><input id="SrvAddr17" name="SrvAddr17" size="30" type="text"> </td>
<td><input id="SrvDate17" name="SrvDate17" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">18.</td>
<td><input id="SrvId18" name="SrvId18" size="30" type="text"> </td>
<td><input id="SrvAddr18" name="SrvAddr18" size="30" type="text"> </td>
<td><input id="SrvDate18" name="SrvDate18" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">19.</td>
<td><input id="SrvId19" name="SrvId19" size="30" type="text"> </td>
<td><input id="SrvAddr19" name="SrvAddr19" size="30" type="text"> </td>
<td><input id="SrvDate19" name="SrvDate19" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">20.</td>
<td><input id="SrvId20" name="SrvId20" size="30" type="text"> </td>
<td><input id="SrvAddr20" name="SrvAddr20" size="30" type="text"> </td>
<td><input id="SrvDate20" name="SrvDate20" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">21.</td>
<td><input id="SrvId21" name="SrvId21" size="30" type="text"> </td>
<td><input id="SrvAddr21" name="SrvAddr21" size="30" type="text"> </td>
<td><input id="SrvDate21" name="SrvDate21" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">22.</td>
<td><input id="SrvId22" name="SrvId22" size="30" type="text"> </td>
<td><input id="SrvAddr22" name="SrvAddr22" size="30" type="text"> </td>
<td><input id="SrvDate22" name="SrvDate22" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">23.</td>
<td><input id="SrvId23" name="SrvId23" size="30" type="text"> </td>
<td><input id="SrvAddr23" name="SrvAddr23" size="30" type="text"> </td>
<td><input id="SrvDate23" name="SrvDate23" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">24.</td>
<td><input id="SrvId24" name="SrvId24" size="30" type="text"> </td>
<td><input id="SrvAddr24" name="SrvAddr24" size="30" type="text"> </td>
<td><input id="SrvDate24" name="SrvDate24" size="30" type="text"> </td>
</tr>
<tr style="display:none">
<td align="right">25.</td>
<td><input id="SrvId25" name="SrvId25" size="30" type="text"> </td>
<td><input id="SrvAddr25" name="SrvAddr25" size="30" type="text"> </td>
<td><input id="SrvDate25" name="SrvDate25" size="30" type="text"> </td>
</tr>
</tbody>
</table>
</div>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
<table id="tblUpload" width="800" border="0" cellpadding="5" cellspacing="0" style="margin-top:10px; margin-bottom:10px; display:none;">
<tbody>
<tr>
<td>
<span class="label">Upload the completed template for all Lumen Service ID(s) and/or Telephone Number(s) you wish to disconnect. If no Service IDs exist, please tell us the Service Description as it appears on your
invoice: </span><span class="redText">*</span> <a href="images/Lumen_Supporting_Ids.png" target="_blank">Click here for Example</a><br>
</td>
</tr>
<tr>
<td>
<table width="100%" border="0" cellpadding="1" cellspacing="0" style="border: 1px solid #841C21;">
<tbody>
<tr>
<td bgcolor="#841C21">
<table width="100%" cellpadding="3" border="0" cellspacing="0">
<tbody>
<tr>
<td> </td>
<td align="right"><input type="button" value="List Services" onclick="uploadShowHide(2)"></td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td bgcolor="#F0F0F0">
<table border="0" cellpadding="5" cellspacing="0">
<tbody>
<tr>
<td colspan="2" align="center"><span class="redText">You will need to save the Template file to a folder on your computer. Open the file, complete and then click the �Browse� button to locate and select the file.
Attachments will be emailed back to the primary Contact Email Address.</span><br></td>
</tr>
<tr>
<td>Upload Template:</td>
<td><input type="file" id="file1" name="file1" onchange="getFileNameWithExt(event)" size="20" maxlength="250"> <a href="images/DisconnectTemplateForPortal.xlsx" target="_blank">Click Here for Template</a></td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
<table border="0" cellpadding="5" cellspacing="0">
<tbody>
<tr>
<td width="500" valign="top" align="left"><span class="label">Additional Notes: </span></td>
<td width="300"><textarea rows="4" cols="34" name="other_information" maxlength="255" onkeyup="return ismaxlength(this)"></textarea></td>
</tr>
<tr>
<td> </td>
<td><input type="submit" id="submit" name="submit" value="Submit"></td>
</tr>
</tbody>
</table>
<br>
<table width="800" cellpadding="5" cellspacing="0" border="0" style="border: 1px solid red">
<tbody>
<tr>
<td>
<span class="smallText">
<b>Disclaimer:</b> Lumen requires thirty (30) days advance notice of disconnection. Because monthly services bill in advance, you may be entitled to a credit after the service is disconnected. Credits should be applied to the next invoice
following the disconnect date. Customer is still responsible for any usage charges incurred for up to ninety (90) days after the disconnect date of the service(s).<br><br> Lumen will use reasonable efforts to rescind a
disconnection/cancellation notice. However, once a disconnection/cancellation notice has been processed, Lumen cannot guarantee that service(s) will be extended beyond the original disconnection/cancellation date. In the event a
disconnection/cancellation notice is rescinded, additional charges may apply. <font color="red">PLEASE <a href="http://www1.lumen.com/disco/page4.cfm">CLICK HERE</a> TO CANCEL OR EXTEND OUT THE DISCONNECT REQUEST OR SEND AN EMAIL TO
</font><a href="mailto:disconnects@lumen.com">disconnects@lumen.com</a>. </span>
</td>
</tr>
</tbody>
</table>
</form>Text Content
For help, please call 1-877-453-8353 (Billing Issue - Option 2, then Option 1) Extend or Cancel Disconnect Request Case number from your previous Request: * Click here for Example If you do not have your Case Number, please contact: disconnects@lumen.com Billing Account Number: * Billing Account Name: * Requestor Name: * Requestor Phone Number: * Requestor Email: * Note: If you use an email that differs from your company named email, this could delay processing of this request, due to required verification steps Do you wish Cancel or Extend?: * Cancel Extend All Services or Specific Services?: * All Services Specific Services List all Lumen Service ID(s) and/or Telephone Number(s) you wish to Extend or Cancel. If no Service IDs are on your invoice, please tell us the Service Description as it appears on your invoice: * Click here for Example IDs, TNs or Descriptions are listed on your invoice. Please limit to 25 or use the Upload Attachment button above for more. Service IDs,TNs or Descriptions Service Address Disconnect Date 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. Upload the completed template for all Lumen Service ID(s) and/or Telephone Number(s) you wish to disconnect. If no Service IDs exist, please tell us the Service Description as it appears on your invoice: * Click here for Example You will need to save the Template file to a folder on your computer. Open the file, complete and then click the �Browse� button to locate and select the file. Attachments will be emailed back to the primary Contact Email Address. Upload Template: Click Here for Template Additional Notes: Disclaimer: Lumen requires thirty (30) days advance notice of disconnection. Because monthly services bill in advance, you may be entitled to a credit after the service is disconnected. Credits should be applied to the next invoice following the disconnect date. Customer is still responsible for any usage charges incurred for up to ninety (90) days after the disconnect date of the service(s). Lumen will use reasonable efforts to rescind a disconnection/cancellation notice. However, once a disconnection/cancellation notice has been processed, Lumen cannot guarantee that service(s) will be extended beyond the original disconnection/cancellation date. In the event a disconnection/cancellation notice is rescinded, additional charges may apply. PLEASE CLICK HERE TO CANCEL OR EXTEND OUT THE DISCONNECT REQUEST OR SEND AN EMAIL TO disconnects@lumen.com. © 2024 Lumen Technologies