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AUTHORIZED UTILITYREPRESENTATIVE FORM FOR THE TELECOMMUNICATIONS CARRIERS
TYPE: [ ] IXC [ X] CLEC [ ] ILEC [ ] Wireless
CERTIFICATEDCOMPANY INFORMATION 1
FEIN/SSN:
Bellerud Communications,LLC
Company Name
Telephone#: 678-436-5590
Dba/fka
3483 Satellite Blvd., Suite 202 S!ON
E O El _ ',/ tL=_"
MailingAddress:
Duluth GA 30096-5800
11
JAN 2 1 2_0
City, State, Zip Code
2023 Sam HoustonAve
Business Location _. ,, _ ,--:. --
Huntsville TX 77340-0000
County:
City, State,Zip Code
..... .._._.......... . _ _. ......._
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_. ,m i_,:_;:_i'_ _::_,<%!;_'2:: ii_!_
RegisteredAgent: Incorp Services, Inc.
Mailing Address: 317 Ruth Vista
Lexington SC 29073-0000
City, State, Zip Code
Pursuant to the Commission'srules and requlations,print or type companycontact for the followingareas:
Rene Bellerud Business LocationAddress
A,
General Manager (Include Address if Different than above)
936-295-9600 / 936-435-9601 / rene.bell@tyler.net
Telephone Number / Facsimile Number / E-mail Address
BusinessLocationAddress
B,
Customer Relations/ComplaintsRepresentative (InculdeAddress thanabove)
ifDifferent
/_ /
TelephoneNumber / Facsimile Number / E-mailAddress
BusinessLocationAddress
C1. Customer Relations/ComplaintsRepresentativefor EscalatedComplaints(IncludeAddressif
different than above)
. /_ /
Telephone Number / Facsimile Number / E-mailAddress
E, t
lest and Repair (Include Address it I_)iMerenthan above)
/- /
Telephone Number / Facsimile Number / E-mail Address
F.
Emergencies (During Non-Office Hours)
/- / --, \/ _,: t_\
_'_ t.. ! I ",/_._
Telephone Number / Facsimile Number / E-mail Address _'_ t_"'_" ! 1i
In addition, please provide the following company contact information to assist in proper routing of
correspondence and invoices:
Janette Dansby Mailing Address
G,
Regulatory Officer (Included Address if Different Address if different than above)
678-436-5590 / 678-802-3483 / jdansby@rtcllc.net
Telephone Number / Facsimile Number / E-mail Address
Janette Dansby
H, Dual Party Mailings (Name)
3483 Satellite Blvd., Suite 202 Duluth GA 30096-5800
(MailingAddress)
678-436-5590 / 678-802-3483 / jdansby@rtcllc.net
Telephone Number / Facsimile Number / E-mail Address
Janette Dansby
Interim LI:C Fund Mailing (Name)
3483 Satellite Blvd., Suite 202 Duluth GA 30096-5800
(Mailing Address)
678-436-5590 / 678-802-3483 / jdansby@rtcllc.net
Telephone Number ! Facsimile Number / E-mail Address
Janette Dansby
J, Universal _Service Fund Mailings (Name)
3483 Satellite Blvd., Suite 202 Duluth GA 30096-5800
(Mailing Address)
678-436-5590 / 678-802-3483 / jdansby@rtcllc.net
Telephone Number / Facsimile Number / E-mail Address
Janette Dansby
K. Gross Receipts Mailings (Name)
3483 Satellite Blvd., Suite 202 Duluth GA 30096-5800
(Mailing Address)
678-436-5590 / 678-802-3483 / jdansby@rtcllc.net
Telephone Number / Facsimile Number / E-mail Address
Jane_e Dansby
-- - 'J
Th_formwas comp_tedby Signature
Account Manager / 1114/2010
Title Date
COMPLETED
RETURN FORMTO: CommissionfSC
PublicService o
Docketing Department
1
PostOfficeDrawer 1649
South
Columbia, 2
Carolina 9211
And
Staff
OfficeofRegulatory
Attn:Jeanne Gordon
1401 MainStreet
South
Columbia, 2
Carolina9201
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