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Instructions

Please use this form to report construction-related/installation damages. Fields with red asterisks are required.

Description of damage *

Name

Please enter your name.

email Address

Your email address

Phone number

Location of damage *

Please list street number, street name and zip code of location of damage

Urgency

If the repair is urgent (can't wait two weeks), please describe the urgency: Wedding on Saturday, Can't get mail, etc.

Previous discussions

If you have already discussed this damage with the office or a foreman, please let us know the details of that interaction.

Customer_status *

Customer

Property owner in neighborhood under installation

Town or County employee

Casual observer

Employee of other utility

Employee of WideOpen

What is your current relationship with WideOpen?

More information

Is there anything else you would like us to know?

Pictures

Please upload images of damage
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png avi mov mp3.

More Pictures

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png.

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

What code is in the image? *

Enter the characters shown in the image.

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Damage Report Form