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<br />08/02/2004 09:40
<br />
<br />9527467094
<br />
<br />INTEGRA TELECOM
<br />
<br />PAGE 02
<br />
<br />90-day Integra Difference .
<br />Claim & Disconnect Notificat on
<br />
<br />To be completed and delivered to your Integra Telecom Customer Account Manager within 90-days of instailati n.
<br />
<br />To qualify for the 90-day 100% Satisfaction Guarantee, you must complete the following inf rmation,
<br />make a copy for your own records and deliver the original claim to your Integra custom account
<br />manager. Integra Telecom must receive notification no later than 90 days after your date of.i stallation
<br />and prior to placing an order for re-installation with your previous provider.
<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 LMg Distance
<br />
<br />o DSL 0 Dedicated Internet Access
<br />
<br />o Web Hosting
<br />
<br />o .Commerce
<br />
<br />Instailation Date
<br />
<br />Contact Name
<br />
<br />Company Name.[JJ.!J,......I!f::.. .~/.Idtf:..........................................._....-.......
<br />
<br />Account No.
<br />
<br />Service Address
<br />
<br />(it
<br />Y.....
<br />
<br />State
<br />
<br />Zip
<br />
<br />Phone
<br />
<br />Fax
<br />
<br />Reason for dissatisfaction: 0 SerVice
<br />
<br />o Product
<br />
<br />o Biiling
<br />
<br />o Outage
<br />
<br />o Other
<br />
<br />. " _ _ __ ~ . _ _" ~_ _ _ _ _ u _ _ _ _ .. _ _ _ _ _ _~, "_ _ _n __ _ _. . ."._._____,..,."".............u....'""...".'u._._.u. _,_'_'n,~'___'""_"'_'_""__'_'__""-""'-'__'"".__'_'"'- -.,",..,",.,..,,,,..,.........
<br />
<br />Customer Signature
<br />
<br />Date
<br />
<br />, '.""-~'."-'-~'-'"'." """,""-,-"~-,-,,.,.,-'~"'.,,,.,~._,_._.",,,._...._..--,..,...._.-._~._~"-'y',..-
<br />
<br />Integra Telecom of Minnesota Vice Pres. of Sales Signature........~......_................
<br />
<br />Date
<br />
<br />'1,g./).1
<br />..._._"_.,"'"""'_...._.,.._...._..'-...,.,.,"'~.".. .,...'"".-,..-,.....,...
<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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