Splice Request

Date Submitted/Received

FBL Customer Company Name(Required)

Enter the Contractual Fiberlight Customer Company Name (not the Customer’s end user company)

Requester's Full Name(Required)

FBL Customer Phone(Required)

Enter your Phone Number for communication

FBL Customer PO#

If applicable, enter the PO number you’re providing or have provided to FBL

Market(Required)

Enter the Market where the work will be done

FBL Customer Email(Required)

Enter the email address that will receive confirmation of this Splice request with a ticket number to reference.

Additional POCs

Add Email Addresses, separated by commas, for any additional POCs to notify

Contract(Required)

If known, please enter your FBL Contract number. If not known, please enter unknown

Order Number(Required)

If known, please enter your FBL Order number. If not known, please enter unknown

Fiber Activity(Required)

Location Description(Required)

Dark Fiber IDs

If known, enter your Dark Fiber Circuit IDs

Priority(Required)

Expedite fee may be applicable

Splice Date Request

Does Customer have existing facilities in requested access point?(Required)

Access Point Ownership(Required)

Is the Access Point Customer Owned Fiberlight Owned or 3rd Party Owned?

If No Above, has Access been Approved?(Required)

Ticket Number for Approved Access(Required)

FBL OSP PM

If known, please enter the FBL PM name, if not known, enter unknown

Description of Request(Required)

Provide Details of Splice Request. Splice Matrix will be completed with your OSP PM (Limited to 350 characters)

Upload Your KMZ File (ZIP required)

Accepted file types: zip, Max. file size: 10 MB.

.ZIP REQUIRED (please compress KMZ file in .ZIP format before uploading)

Upload Additional Documents

Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, Max. file size: 10 MB.

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