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2. Instructions
   Please note that you should contact your cable provider first with most questions. If your provider cannot answer your question or fix your cable problem, you can use this form to contact City Staff and the Cable Commission. Note that your submitted complaint is a public record under the Virginia Freedom of Information Act.
4. First Name*
5. Last Name*
7. Address1*
9. Address2
11. City
12. State
13. Zip*
15. Phone*
16. Email*
17. Preferred Method of Contact

    1. Phone
    2. Email
19. Which Utility are you having issues with:

    1. Phone
    2. Internet
    3. Television
    4. Electric
20. What type of issue are you having:

    1. installation
    2. current service
    3. maintenance
    4. damage
21. Who is your provider?

    1. Comcast
    2. Cox
    3. Verizon
    4. Dominion
23. Public Maintenance Complaints

    1. Low hanging branches
    2. Tree limbs on cables
    3. Abandoned pole
    4. Low hanging cables
    5. Damaged handbox
    6. Damaged pedestal
    7. Other
24. Load File
26. Describe your complaint and location of the issue
28. What is your 'ticket number' from your contact with your service provider?
29. When did you contact your cable provider?
    When did you contact your cable provider?

    When did you contact your cable provider?
31. Any other details?
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

* indicates a required field