Damaged Wireless Facility Form
If a damaged facility utility company can be identified (COX, Century Link) , please contact COX at https://www.cox.com/residential/contactus.html or Century Link at 800-526-3557
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
example@example.com
Damaged Wireless Facility Information:
The nearest exact address to the damaged wireless facility or the street names of the nearest intersection
*
Type of damage
Damaged /Exposed utility box/ CATV box
Exposed wiring
Missing hand hole cover
Other
Problem description
Upload photos/video
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Additional comments
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Should be Empty: