Form Center

2. Tennessen Warning Privacy Notice
   You are being asked to answer questions and provide information that is classified as confidential data under Minn. Stat. § 13.39 (2016). This information will be used by City of Wayzata employees and its agents to monitor Mediacom’s adherence to its agreements with the City of Wayzata and to resolve technical/customer service issues of residents who are Mediacom customers. The information you provide may be shared with Mediacom to help resolve your complaint. You are not required by state law or City Code to answer questions or provide the information requested. However, a refusal to answer questions or provide the information requested will prevent the city employees from assisting with your complaint.
4. First Name*
6. Last Name*
8. Email Address
10. Daytime Phone Number*
11. Alternate Telephone Number
13. Service Address*
15. City*
16. Zip*
20. Are you currently a Mediacom subscriber?*

    Please check yes or no.

    1. Yes
    2. No
22. If yes, what services do you have with Mediacom?*

    Please check all boxes that apply.

    1. Cable TV
    2. Internet
    3. Phone
24. What is the general nature of your complaint?*

    Please check the box that applies.

    1. Cable Service Rate or Cost
    2. Technical Problem
    3. Billing Concern
    4. Programming Concern
    5. Customer Service
    6. Unburied Cable/ Property Issue

    1. General Inquiry
    2. Equipment
    3. Service Response Time
    4. Installation
    5. Technical Quality/Outages
    6. Other
26. When was the first time you contacted Mediacom about the issue?*
28. Please provide specific details regarding your concern:*
    State what is the technical/customer service issue you are experiencing. Include any dates of a timeline of when you noticed the issue, when you first contacted Mediacom and any follow up calls you have made to request service.
30. What is your requested resolution? (if any)
32. Click submit when finished. This will be sent to Mediacom to resolve and to the City of Wayzata to monitor. Thank you.
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field