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All complaints are treated
confidentially, professionally and fairly.
File A Complaint With Consumer Affairs
Your Information
Full Name
Gender
-- Select --
Male
Female
Preferred Contact Number (please fill one of the below)
-- Select --
Home Phone
Work Phone
Cell Phone
Email
Home Phone
Work Phone
Cell Phone
Email Address
Have you attempted to resolve this issue with the company?
-- Select --
Yes
No
Company Information
Name of Company
Name of Manager / Owner
Contact Number
Complaint Information
Is the complaint about a car, bike or boat?
-- Select --
Yes
No
Product
-- Select --
Yes
No
Name of Product (please include make, model and number)
Date Purchased
Service
-- Select --
Yes
No
Type of Service
Nature of Complaint
-- Select --
Advertising
Billing
Contract
Credit/refund
Customer Service
Delivery
Lost/Damaged Goods
Product Quality
Refund or Exchange
Repairs
Selling
Service
Warranty
Briefly describe the details of your complaint
Enter text here
Car, Bike or Boat
Vehicle Model
Vehicle Make
Date of Purchase
License Number
Date problem started
How many days has the vehicle been out of service for repair?
Nature of Complaint
-- Select --
Advertising
Billing
Contract
Credit/refund
Customer Service
Delivery
Lost/Damaged Goods
Product Quality
Refund or Exchange
Repairs
Selling
Service
Warranty
Briefly describe the nature of your complaint
Enter text here
Resolution
Do you have any documents supporting your complaint?
-- Select --
Yes
No
If yes, what are they?
Receipts
service records
letters
email
statements
quotes
invoices
professional opinion
What would satisfy your complaint?
-- Select --
Refund
Reimbursement
Replacement
Repairs
Apology
