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Name
e-mail  
Address
Customer Account Number
STB Number  
Box1
Box2
Box3
Smart Card Number  
Box1
Box2
Box3
City
Tel./Cell  
Fax  
Number of TV sets  
Make of TV sets  
Name of Local Cable Operator  
Phone of Local Cable Operator  
Nature of Complaints:    
(i) Snow in picture on channel(s)  
(ii) Blinking in picture on channel(s)  
(iii) Lines in picture on channel(s)  
(iv) Problem in sound of channel(s)  
(v) Other problems  
Channel (s) name
Problem Description