Your Home Wifi
Xfinity Customer Sheet
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Representative Name
*
Representative Phone Number
*
DOB
B or Q #
*
Customer Name
Store/Area
*
Address
*
City
*
State
*
Zip Code
*
Phone Number
*
Email
*
SSN
Ported #
Native #
Card #
*
Account Number
Reconciliation Please type YES / NO
Rep ID #
*
Work Order #
*
Order ID
Customer currently has the following Services:
TV
Internet
Voice
Home Secure
None
Customer is ordering/adding the following services.
TV
Internet
Voice
Home Secure
None
*
Package Details
Installation Date/Time
Mon ____/____
Tues ____/____
Wed ____/____
Thurs____/____
Fri ____/____
Sat ____/____
Sun ____/____
Date Field
Please Add Time
Appointment Time Between ______ : ______ AM PM and. ______ :______ AM PM
Notes:
Customer Initials
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