Verizon Notice of Customer Dispute Page 1 of 2
Verizon is committed to customer satisfaction. If you have an issue regarding your service that cannot be resolved with our customer service representatives (at 1-800-VERIZON), you may choose to either arbitrate or mediate the issue. You can also communicate any issues you may have with your Verizon service with the Better Business Bureau (“BBB”), or federal, state, or local government agencies, and if the law allows, they can seek relief against Verizon on your behalf.
Please use this form to provide notice to Verizon only if you intend to seek mediation or arbitration. Please complete this form in its entirety and keep a copy for your records. A Verizon representative will respond to you within 30 days of receiving this form.
Please check the appropriate box below to indicate whether you would like to participate in the Verizon mediation program or arbitrate your dispute with the American Arbitration Association (“AAA”):
: Voluntary Mediation. In Verizon’s mediation program, we will assign an employee who is not directly involved in the dispute to help both sides reach an agreement. This program is entirely voluntary, and you are not bound by the mediator’s proposal unless you agree with its terms. Participating in mediation does not waive any rights you may have to seek other ways to resolve your dispute, including arbitration, if the mediation is unsuccessful.
: Arbitration. Arbitration is an alternative dispute resolution process in which a neutral third person (one or more arbitrators) evaluates the position of each party to the dispute and renders a decision. Once the arbitrator renders a decision, it normally is final and binding on the participating parties. You must send Verizon a notice of the dispute in writing at least 60 days in advance of initiating the arbitration. Follow the directions on this form in order to provide Verizon proper notice. Even if you complete this form, you must contact the AAA to initiate the arbitration. You can get procedures, rules and fee information from the AAA (www.adr.org).
Completed forms should be sent by email to NoticeofDispute@Verizon.com or by mail to:
Verizon Dispute Resolution Manager One Verizon Way, VC54N090 Basking Ridge, NJ 07920-1097
Account Owner Name:
Billing Address:
Account No:
Billed telephone number (if applicable):
Alternate contact phone number:
Email address (optional):
Verizon Notice of Customer Dispute Page 2 of 2
Briefly describe the nature of your dispute and attach any supporting documents:
Briefly describe the relief you seek (e.g., credits, refunds, service improvement, termination of account). Be sure to give specific amounts as to any credits or refunds sought:
Are you represented by an attorney? |
Yes |
No |
If you are represented by counsel, please provide your attorney’s contact information below:
CERTIFICATION OF CUSTOMER OR REPRESENTATIVE
I hereby certify that I am the account owner of the above account(s) or a duly authorized representative of the account holder.
Signature of Account Owner or Authorized Representative:
Date:
CERTIFICATION FOR MEDIATION REQUEST
I understand that any mediation proceedings are confidential and that if I choose to participate in Verizon’s internal voluntary mediation program, I cannot use any statements made during it to settle my dispute in any subsequent legal proceeding, including arbitration or a small claims proceeding, between Verizon and myself, or my client. I will not disclose any statements made or agreement reached during the mediation. By my signature below I acknowledge that mediation is entirely voluntary and I specifically agree to the terms of the mediation as set out above and waive any right to challenge them in any forum.
Signature of Account Owner or Authorized Representative:
Date:
