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<br />0B/02/-2004 09:40
<br />
<br />9527467094
<br />
<br />INTEGRA TELECOM
<br />
<br />PAGE 02
<br />
<br />90-day Integra Difference
<br />Claim 61 Disconnect Notificat on
<br />
<br />To be completed and delivered to your Integra Telecom Customer Account Manager within 90-days of installati n.
<br />
<br />To qualify for the 90-day 100% Satisfaction Guarantee, you must complete the following in
<br />make a copy for your own records and deliver the original claim to your Integra custom
<br />manager. Integra Telecom must receive notification no later than 90 days after your date of i
<br />and prior to placing an order for re-installation with your previous provider.
<br />
<br />rmation,
<br />
<br />account
<br />stallation
<br />
<br />I am not 100% satisfied with Integra Telecom's services. I plan to switch back the following services to my previo s provider:
<br />
<br />o Local Service 0 Long Distance
<br />
<br />o DSL 0 Dedicated Internet Access
<br />
<br />o Web Hosting 0 Commerce
<br />
<br />Installation Date
<br />
<br />Contact Name
<br />
<br />Company Name.t.L!?,.......~t:....~/.kK............................................... Account No.
<br />
<br />Service Address
<br />
<br />City........
<br />
<br />State
<br />
<br />.... Zip
<br />
<br />'..on.......,............._........"."._...........'''"'"''..................."...............-........,...'"""'.,..--......-.......'"'...--,......".,.
<br />
<br />Phone
<br />
<br />Fax
<br />
<br />Reason for dissatisfaction: 0 Service
<br />
<br />o Product
<br />
<br />o Billing
<br />
<br />o Outage
<br />
<br />o Other
<br />
<br />..... ,........_.....__.._....,.,.__".,......,,,.,....,....__._......n._n.._.....",..._.',," ".,.",,~.~d'~~'.,,",....,.,..__,~___""".'_"'_'.'~'.,~~,~....,..,..~._-,...,.'"."~'-'~'-~'~'--'-' ..~.__.__.~,~-"".".,-,--,",---,~",- ~~,.,~~_._~,,",,"""'~'-'-
<br />
<br />Customer Signature............................................................ ..... ................................................................... ..... Date ..........................
<br />
<br />
<br />Integra Telecom of Minnesota Vic~ Pres. of Sales Signature ..........~..,..... .... ........ Date......f{~.~.:.~t........
<br />
<br />Please moil to:
<br />
<br />Integra Telecom of Minnesota
<br />Customer Service
<br />651 Edgewood Drive North
<br />Baxter, MN 56425
<br />
<br />Guarantee 6/03
<br />
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