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Account #1 Identification (max. 6 digits): _ _ _ _ _ _
Account #1 Telephone number (including area code): __________________________
Telephone number of receiving station (including area code) : ____________________
Reporting Format:
_________________________________________________________________________________________
Account #2 Identification (max. 6 digits): _ _ _ _ _ _
Account #2 Telephone number (including area code): __________________________
Telephone number of receiving station (including area code): ____________________
Reporting Format:
UDACT-100A INFORMATION FORM
9 Contact ID
9 SIA
9 Contact ID
9 SIA
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