Emergency Address modification form

If you wish to associate a different emergency address with your Softphone service, complete this form.

Fields with an asterisk (*) are mandatory.

Videotron account number * For example: 12345678-123-1

Last name *

First name *

Videotron phone number * For example: 514-555-5555

Email address *

Language of correspondence *

Emergency Address
Number *

Street *

Apartment

Postal code *

City *

Province *