usfmonth.pdf

Idaho Universal Service Fund Form 1.0
Due Date: First of the Month Revised 10/19
Company name:
Reporting Period:To
Local Exchange Services
# of Lines Surcharge
1. Residence Lines x .25
2. Pro-Rated Charges
3. Business Lines x .44
4. Pro-Rated Charges
5. Total Local Surcharge Revenues
(Sum Lines 1 through 4)
MTS/WATS Type Toll Services
6. Intrastate Billed MTS & WATS Minutes
7. Surcharge Rate Per Minute $0.0070
8. Total MTS/WATS Surcharge Revenues
(Line 6 X Line 7)
9. Intrastate Billed MTS & WATS Revenues
Surcharge
10. Total Surcharge Revenues
(Sum Lines 5 and 8)
Prepared By:Phone:
(Please print)
E-MAIL:
Please Make Checks Payable To:Questions?
Idaho Universal Service Fund CALL ALYSON ANDERSON, ADMINISTRATOR
1964 North 300 East Phone: [phone] Fax: [phone]
Centerville, UT 84014-1085 E-MAIL: [e-mail]