Customer Name (as filed with FCC):  Insert the name of the legal entity associated with the FCC 499 Filer ID for which this form is being completed. 

FCC 499 Filer ID:  Insert the FCC 499 Filer ID for which this form is being completed. 

Link to FCC website with 499 Filer ID:
Click on the link below to be directed to the FCC’s 499 search website and enter your 499 Filer ID number: http://fjallfoss.fcc.gov/cgb/form499/499a.cfm

Click on Submit Search.  From the Search Results page, click on your company name, which
directs you to the Detailed Information page.

• Copy the new URL from your browser address bar and paste it into the space provided on the form.
• Please also print or create a .pdf of the Detailed Information screen shot and attach it to this form.

For example, the link to tw telecom's Detailed Information page is:
http://fjallfoss.fcc.gov/cgb/form499/499detail.cfm?FilerNum=825897

• Contact Name:  Name of person whom tw telecom should contact with questions regarding this form.
• Contact Title:  Title of person whom tw telecom should contact with questions regarding this form.
• Contact Phone:  Phone number of person whom tw telecom should contact with questions regarding this form.
• Contact Email:  Email address of person whom tw telecom should contact with questions regarding this form.
• Name of Person Authorized to Certify:  Name of person legally authorized to sign this certification on behalf of the 499 Filer for which this form is being completed. Title of Person Authorized to Certify:  Title of person legally authorized to sign this certification on behalf of the 499 Filer for which this form is being completed.

Customer Certification

1. Please check each box that applies to the 499 Filer for which this form is being completed.
2. Customer is certifying that this statement is true for the 499 Filer for which this form is being completed.
3. By signing this certification, Customer is acknowledging that it has read and understands these tw telecom policy statements.
4. List all accounts associated with the Filer ID for which this form is being completed and for which all services billed on the account are exempt from tw telecom's FUSF charge because they are resold in the form of telecommunications or interconnected VoIP service.  Do not list accounts that are partially exempt.  If such accounts exist, please contact your account representative to have exempt and non-exempt services split onto separate accounts.
5. List all accounts associated with the Filer ID for which this form is being completed and for which all services billed on the account are NOT exempt from tw telecom's FUSF charge because they are NOT resold in the form of telecommunications or interconnected VoIP service.  Do not list accounts that are partially exempt.  If such accounts exist, please contact your account representative to have exempt and non-exempt services split onto separate accounts.

Instructions for Submitting tw telecoms Universal Service Fund Contributor Certification Form

1. Complete the electronic version of the form, print, and sign the completed form.
2. Attach a copy of the FCC Detailed Information screen shot that confirms your 499 Filer ID Status.
3. (See above for more detail.)
   The FCC 499 Filer ID website: http://fjallfoss.fcc.gov/cgb/form499/499a.cfm 
4. Fax the entire package to (720) 225-5678 to:  tw telecom Tax Exemption Analyst OR scan and email together with the electronic file to the email listed below.
5. Email the .xls electronic file to: TaxExemptionAnalyst@twtelecom.com