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Customer Information
Please provide the information below and a customer service representative will contact you as soon as possible.*** THIS REQUEST IS NOT COMPLETE UNTIL A REPRESENTATIVE CONTACTS YOU DIRECTLY FOR VERIFICATION***
CDE Account #
*
Please include entire account number, including the 3 digits after the dash.
Name on Account
*
First
Last
Service Address
*
Street Address
Address Line 2
City
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American Samoa
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California
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Ohio
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Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Date to Disconnect
*
MM slash DD slash YYYY
New Service Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Date to Connect at New Service Address
*
MM slash DD slash YYYY
Check all that apply
*
Electric
Broadband
Phone
*
Email
*
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Name
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