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Voice Data Both
Switch
GSM TDMA
Trouble (Select all that apply)
All Circuits Busy
Audio One Way
Call Fail
Crosstalk
Dead Air
Distorted Audio
Dropped Calls
Echo
Low Signal
Missed Calls
No Service
No Signal
Screech
Signal Change
Static
Voice Mail
Unable to Originate Calls
Unable to Receive Calls
Unable to Originate SMS/MMS
Unable to Receive SMS/MMS
Unable to Wap (Provide information in Comments)
Other (Provide information in Comments)
Call Directions
Data Directions
All
Land to Mobile
Plateau to Plateau
Mobile to Land
Plateau to Other Carrier
Mobile to Mobile
Other Carrier to Plateau
Customer Information
Account Name: As it appears in billing
Contact Name:
Cellular Number:
Contact Number:
Address or Cross Street at Time of Trouble: Address: City: State:
Date of Trouble: 00/00/08
Alcatel
NEC
HP
Firefly
Sony Ericsson
Motorola
LG
Audiovox
Nokia
Other
Comments
Email Address
