E911 Change Order Use this form to update your E911 user information. Action(Required)Select the E911 action you are trying to perform. Update Existing E911 Information Add NEW E911 Information Remove existing E911 Information Remote Worker(Required) Yes No Address InformationThis information must be accurate and updated immediately if an end users information changes. Update address associated with E911 Phone Number(Required)This is the number CURRENTLY associated with an E911 address that you wish to update to the information following. Any address associated with this number will be deleted. Be sure to verify this number is not in use by other users as this action can not be reverted.Remove E911 Address assigned to Number(Required)This number will have its E911 address associated with it removed.Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Address Type(Required)You must specify one of the following items. If you select 'None' or 'Residential' you can not specify an Address Type Number. For all other entries, you MUST specify the Address Type Number. ApartmentBasementBuildingDepartmentFloorFrontKeyLobbyLotLowerOfficePenthousePierRearResidential (Single Family Home)RoomSideSlipSpaceStopSuiteTrailerUnitUpperAddress Number(Required)Must be empty if address type is None or Residential NOTE For office locations, You may provide the floor detail and add specific location info to the Address Type Number. e.g.: 2_NW_CORNER, 2_Room12 ** No spaces are allowed ** PBX InformationThis information is required to successfully update your PBX configuration.System Identifier(Required)If you have a Switchvox this is your REGCODE. Otherwise enter the URL to your PBX instance. 911 Number(Required)Outbound phone number currently used on PBX. This should match your provider format usually 1 + 10 Digits Keep Phone Number(Required)If you select NO, this number will be removed from your account and no longer available for receiving or making calls. You will still be invoiced for the month for the use of the number. Yes No Internal Extension(Required)This is the internal extension that the E911 number should be redirected to for inbound calls.Please enter a number from 100 to 9999.REMOTE WORKER WARNINGThe FCC requires that any remote worker connected to a multi-line phone system (PBX) MUST be able to make and receive 911 calls that properly report their current address location. It is your responsibility to assure that the proper 911 information is functional before allowing the user to connect to your system.FCC Fact SheetHiddenApproverAuthorized Approver Contact Name(Required) First Last Email(Required) Phone(Required)ExtensionConsent(Required)This is the name and contact info of the individual authorizing and approving the change request. This should be the name, email address, and contact phone number. By populating this you are affirming that you have validated the correct information and are providing accurate 911 information and legal responsibility and accuracy in accordance with FCC E911/911 regulation and recent Kari's Lay and RAY BAUM'S Act. I agree to and understand the E911 FCC Policy. Δ
