alt-positive-id

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Mail: Frontier OSC
P.O. Box 5166
Tampa, FL 33675
Fax: (844) 387-2500
Email: [email protected]
Positive Identification Form
Customer/Business Name:
Service Order #:
Telephone #:
Service Address:
Street
City
Zip
State
SPECIFY FORMS OF IDENTIFICATION PRESENTED TO THE NOTARY PUBLIC/ FRONTIER.
Two of the following forms of identification are required, and at least one must be a picture ID and
at least one must be state/government issued.
Social Security Card
Drivers License or State-Issued Identification Card
Birth Certificate
Other (i.e. Passport, Business Tax ID Form)
I,
(Provide SSN)
(Provide Number)
(Print type of identification and any associated number)
declare under penalty of law, that the identification
(Print your name)
presented to the Notary Public is, to the best of my knowledge, authentic.
Signature
Date
(This section is to be filled in by Notary Public)
Notary Public
Instructions
Name:
License #:
Witnessed on:
[STAMP]
Signature
PosID_All.doc
Revised: 6/1/17
1) Fill in all appropriate blanks on this form.
2) Check off the appropriate forms of ID that will be presented to
a Notary Public for identification.
3) Have the form completed and notarized. Submit copies of the
identifications presented to the Notary Public with the
completed notarized form to the applicable address shown
above or fax number.
4) Make a copy of this form for your records if you mail the
originals to the applicable address shown above.
5) We will make the necessary changes or updates to your
account. If you have any questions regarding this form, please
contact Frontier at 800-921-8101 (residential customers) or
800-921-8102 (business customers).
 Archive Only – Faxing to Frontier Offline - Retail Store Processed POS ID
 Archive Only – Fax Recd & POS ID Processed by Offline ______________
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