CB Indirect Leads

    Customer Email* (E.G. NAME@EMAIL.COM FORMAT):

    REQUESTED FOLLOW-UP DATE (e.g. mm/dd/yyyy format)

    The following entries are required with CB Promotion Orders

    Choose the promotion name that is associated with the sale of the Cox Business and RapidScale product or service.

    Is this an existing Cox customer?*

    Cox ICOMS Account # (Located in the OPTIX Billing ID/CABS field associated with the Bundle Service Promotion - MUST be format 000-0000000-00 format, enter 000-0000000-00 if unknown)

    Cox OPTIX Account ID # (Enter OPTIX Account ID # associated with new - MUST be format 0000000 format, enter 0000000 if unknown)

    Important: The Cox ICOMS Account # or the Cox OPTIX Account ID # is required for processing the customer's MRC Promotion Code associated with the Bundled Service Promotion.

    Thank you for your message. It has been sent.

    There was an error trying to send your message. Please try again later.

    The captcha is expired, please reload a page.
    There was an error trying to send Salesforce. Please try again later.