File a Complaint

Please complete this form providing the name and address of the individual or business against whom the complaint is made, and the name and address of the person making the complaint. Provide a detailed description of the complaint. Complaints may be made anonymous. If you want to do so, please write Anonymous in the boxes under Individual Making Complaint.

Complaint Form

* Indicates required information.
** You must provide either a Individual or Company Name to file the complaint against.

 

 

Individual Making Complaint:

 

 

Individual or Business Named in the Complaint:

*First Name
*Last Name
*Company
Mailing Address
City
State
Zip Code
Phone

 

 

List below any witnesses to the incident or situation, giving full names and addresses:

 

 

Please provide a detailed description of the complaint below:

 

 

Terms & Conditions:

I understand that the information provided above will be used in efforts to resolve my problem and may be shared with the party complained against. It may also be used to enforce applicable state laws.

A copy of this submition will be sent to your email address if provided.

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