Out of Service Claim

Out of Service Claim Refund

This Form is for all Prime One customers that have experienced an outage due to Prime One. All Prime One Customers have the ability to claim $5 for every hour they are out of service. Please complete form Below to Receive Gift Card.
Please Input your Complete Address *

Street Address

Street Address Line 2

CityState

Zip Code
Full Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Number of Hours out of Service*
Total Refund Claim
Should be Empty:

Out of Service Claim Refund