Customer Initiated Disconnect Form For help with this Form please call 877-2-LEVEL3 (Option 3).
For all Level 3 Services you wish to completely disconnect, please be sure to accurately complete ALL REQUIRED FIELDS (*) below to help ensure timely processing of your request.
IMPORTANT NOTICE! If you are Porting ANY Voice Services under this account to a new service provider, DO NOT fill out this Form for those Services. The winning carrier must submit the request for those Services to LNPportouts@level3.com. Please note that only Voice Services will port out to a new carrier; Data Services do not port out and will continue to bill until they are requested to be disconnected via this Form.
1. Your Company Information 2. Your Contact Information
*Level 3 Billing Account Name *Your Name
*Level 3 Billing Account Number *Your Phone #
(As seen on your Level 3 invoice) *Your E-mail Address
3. Service Information
*I wish to disconnect the Service(s) below because:

I am upgrading or replacing services with Level 3:

Pricing?

What experiences with Level 3 led you to disconnect your services?

Internal Business Factors?

* List all Level 3 Service ID(s) and/or Telephone Number(s) you wish to disconnect. If no Service IDs are on your invoice, please tell us the Service Description as it appears on your invoice.
These IDs, TNs or Descriptions can be found on your Level 3 Invoice. Please separate each with a comma (,).		   If the free form text box limitations to the left have been exceeded, please attach up to 3 documents below. These may include Service ID(s)/Telephone Number(s) and Service Addresses, Letters of Authorization, Invoices, Contracts, etc. You will need to save the file to a folder on your computer then click the “Browse” button to locate and select the file. Attachments will be emailed back to the primary Contact email address(s).
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*Are these Voice Services: YesNo

 

*Requested Disconnect Date for the Service(s) above (MM/DD/YYYY):
Must be at least 30 days from today's date. See below.

*If you are disconnecting a Private Line, EPL, Wave or Colocation Service, indicate here that you understand all IP & Voice Services utilizing these access components will also be disconnected

* I understand that by submitting this Disconnect Form, I am authorizing Level 3 to act on my behalf to disconnect any third party cross connects for which I originally required Level 3 or its acquired companies to issue LOA/CFA

Unless otherwise agreed between the parties, the Service identified for disconnection will be disconnected upon the later of (i) thirty (30) days after Level 3's receipt of this completed Disconnect Request Form or (ii) the requested date of disconnection specified below for Level 3 products and services. If the Service is being disconnected prior to the end of the committed Service Term, early termination charges may apply as agreed between the parties.

Level 3 will use reasonable efforts to rescind a disconnection/cancellation notice. However, once a disconnection/cancellation notice has been processed, Level 3 cannot guarantee that service will be extended beyond the original disconnection/cancellation date. In the event a disconnection/cancellation notice is rescinded, additional charges may apply. ALL REQUESTS TO CANCEL OR EXTEND OUT THE DISCONNECTS MUST BE SUMBITTED TO disconnects@level3.com.
4. Additional Information
Your feedback is important to us. Please tell us:
Any other information you feel would assist with this disconnect.

How can Level 3 better serve your needs in the future:
For help with this Form please call 877-2-LEVEL3 (Option 3).