City of Rancho Palos Verdes Electronic Submittal

2. Contact Information
4. Customers experiencing difficulties with their internet connection are urged to contact Cox's Customer Support department at 1-800-234-3993 prior to submitting this form. Kindly complete this form only if you require City Staff to escalate your concern to Cox’s Government Affairs Team.
6. First Name*
7. Last Name*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Home Phone Number*
18. Cell Phone Number
20. Daytime Phone Number
21. Email Address*
23. Please Specify General Inquiry, Request for Service or Complaint*
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25. 1. Receive an email copy of this form.
26. Email address

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27. Submit Submit and Print

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