Service Outage Credit Claim Form

Service Outage Credit Claim Form
Submit your claim for service credit due to a recent service outage. Please provide accurate details to help us process your request efficiently.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Service Address (where outage occurred)
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Account Number (if applicable)
Type of Service Affected
Date When Outage Started
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date When Service Was Restored
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Estimated Duration of Outage (in hours)
Please describe the impact of the outage on your service or business.
Upload any supporting documents (e.g., outage notices, bills, proof of loss)
Cancelof
Have you reported this outage to customer service?
Should be Empty: