Frontier Communications Claim

CLAIM FORM
for
FRONTIER COMMUNICATIONS of AMERICA, INC.
and
FRONTIER COMMUNICATIONS OF THE CAROLINAS LLC
RESTITUTION

Please print legibly and keep a copy for your records.

Name(Required)

First Middle Last

Account #

Mailing Address(Required)

Street Address City State ZIP Code

Phone #(Required)

e-mail Address(Required)

I certify that I had internet service with Frontier Communications and was not provided the internet speed I was promised in my service agreement.

Signature(Required)

Date(Required)

Your signature on this form is your sworn statement that you may be entitled to restitution.