Please enable JavaScript in your browser to complete this form. - Step 1 of 2Name *FirstLastPhone number *Service address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeIs this outage due to infrastructure damage? *YesNoI'm not sureNextType of service *Click to selectFiberWidebandLTEI'm not sureProblem experienced *Click to selectNo connectivity - complete outageIntermittent outagesDegraded performanceOtherPlease describe the problem *Please describe the damage *Do you know the party responsible for causing damage? *YesNoName of responsible party *Phone number of responsible party *Was an 811 Locate Request submitted for this location? *YesNoI don't knowEnter Locate Request Ticket Number *Please attach any photos of worksite and damaged infrastructure Click or drag files to this area to upload. You can upload up to 5 files. Additional comments (optional)Data collected will NEVER be shared with third parties for marketing, advertisement, or any other purposes. View our Privacy Policy and other legal documents here. Submit
