Customer Information

Please DO NOT use
this form for:

• service problems
• service outages
• immediate assistance
needs.

This may delay in getting you the quickest possible assistance. Instead, refer to the Emergency Technical Support numbers.

	* = Required
Customer Name:	*
Service Address:
10-Digit Daytime Phone #:	*
E-mail Address:	*
Service Area:	Select... Brevard Fort Lawn Fort Mill Gilbert Heath Springs Kershaw Lake Wylie Lancaster Rock Hill Tega Cay York *
Preferred Method of Contact:	E-mail Telephone
Best time of day to call:	Select... Morning Afternoon *
Service Type:	Select... Residential Business *
Are you an established Comporium customer?	Yes No
If yes, what is your account number (If known)

Comporium Services

*Choose the service(s) you would like information or assistance with.
A customer service representative will be in contact with you as soon as possible.

Local Telephone     Telephone / Hosted VoIP / System Sales     Long Distance     Web Design / Hosting     Wireless     Comporium Publishing / Directory     Digital Cable     Computer / Network Solutions     Internet     Security

Please use this area to let us know the kind of information you are requesting. Include any information you think will help us understand your needs.

    

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