Escalation ERT

This form is for missing/misapplied payments when the issue has been escalated to SLT, BBB, FCC, or Legal

Backend Form Name

GroupName

FileName

Subject

Is New Incident Attachment

NoYes

T-Mobile Employee Information

Do NOT enter the customer's email address in this field.

If a valid T-Mobile address is not entered, you will not receive any updates on the case.

T-Mobile Employee NTID/ADID *

T-Mobile Employee Email Address *

Re-enter T-Mobile Employee Email Address *

Email Addresses does not Match. Please Re-enter

Support / Customer Information

Is this a current T-Mobile Customer? *

BAN/FAN *

This field must contain 9 digit(s).

MSISDN / Mobile Number

This field must contain 10 digit(s).

Account type *

Is this Metro customer? *

First Name *

Last Name *

Street address Line 1 *

Street address Line 2

City *

State *

Zip *

Is this Equipment or Bill Payment? *

Transaction Date

Payment Amount $ *

Order ID

Payment ID

Plan Number

Did the customer pay cash? *

How was the payment made? *

Method of payment? *

First six digits of the card or bank account number

This field must contain 6 digit(s).

Last four digits of the card or bank account number *

This field must contain 4 digit(s).

Store Number

Check Number

Please Specify *

Is there any additional information we should know?

Supporting Documents(s)

Attach a document from the list below. For your security, please ensure ONLY the last four digits of the card or bank account number is visible.

Attach Document(s)

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​Escalation ERT

T-Mobile Employee Information

Support / Customer Information

Supporting Documents(s)

Escalation ERT