COPY REQUEST FORM Please complete this form and fax

							                                      COPY REQUEST FORM

 Please complete this form and fax to:
 Policy Division
 Fax # 775-684-6110

                  Please allow up to 5 business days to process your request.


REQUESTED BY:                                           CHECK ONE:

                                                        COPIES _______ ($.25 / page)
                                                        (no fee for copies sent via e-mail)

COMPANY NAME:                                           CHECK METHOD OF DELIVERY:

                                                        PICK-UP ___       MAIL ___

                                                        FAX ___     ($1.00 / page over 5 pages)
ADDRESS:                                                                  Note: Limit 20 faxed pages

                                                        FED-EX ___ Account #___________________________
SUITE NUMBER:
                                                        E-MAIL ___ Address_____________________________


CITY:                                                   DOCKET NO(S).:

STATE:             ZIP:


PHONE:

FAX:

Please note: When requesting copies of interconnection agreements, please list by the companies the agreement is
between. Please include a docket number if you have one.
DOCUMENTS REQUESTED:




 Signature of Requestor _________________________________ Date ______________

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                              Internal Use Only:
TOTAL PAGES COPIED:                                     TOTAL PAGES FAXED:


DATE REQUEST FILLED:                                    FILLED BY: