CPE REQUEST FORM


Today’s Date


P/Up Date _Friday May 08___



Buffer Number : GR3/09ACS


Service Center or contractor Name :


ACS BRANFORD/GROTON

All Same Day Orders Must Be Approved by Supervisor: ______________________________


Reason for same day: ____________________________________________________________


Qty

Type

Remotes

Cords

20

Modems (3.0)




Modems (2.0)



30

EMTA-CDV



10

Routers/Gateway Modems




SMC Commercial Modems



20

SA Standard Digital

20

20

15

SA Host HD DVR

15

15

10

SA Standard DVR

10

10

15

SA Host HD Digital

15

15


Cable Cards(SA)







HSI Self Install Kits ____20_________

Y Audio Cables ____________

RCA CABLES ___10_________ 6ft ____________

COMPONENT Cables _____15_________ 12ft________________

DVI Cables ________________ 6ft________________

HDMI to DVI Cables ________________ 10ft________________

HDMI to HDMI Cables _____15___________ 10ft________________


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