Telecommunications Account Quarantine Release Request
Submit a request to release a telecommunications account from quarantine. Please provide accurate and complete information to facilitate prompt processing.
Full Name of Requestor
*
First Name
Last Name
Contact Email Address
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Account Number or Reference
*
Service Provider
*
Please Select
AT&T
Verizon
T-Mobile
Sprint
Other
Account Type
*
Mobile
Internet
Landline
Other
Reason for Quarantine
*
Requested Release Date
*
-
Month
-
Day
Year
Date
Supporting Documents (if applicable)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Are you the account holder?
*
Yes
No, I am an authorized representative
If you are not the account holder, please specify your relationship to the account holder
Additional Comments or Special Instructions
Signature (to confirm the accuracy of the information provided and authorize the release request)
*
Submit Request
Submit Request
Should be Empty: