Online Complaint Form

Consumer Hotline: 1-800-392-5658 or 334-242-7335

Please fill out the form completely and describe your situation as accurately as possible. All fields with an * are required.

Prefix»		*First Name»		Middle Initial»
*Last Name»				Suffix»

Individual/Firm Name »

Address »

Address2 »

City »

State/Province Abbrv »

	Zip/Postal »
Phone » (123-456-7899)

*Date Incident Occurred » (Must be mm/dd/yyyy format)
Did you sign a contract? »
Have you told the firm/person of your complaint? »
Product, service or action involved »
Estimate of amount involved »	$
How were you first contacted or given info about product/service? »
Have you consulted an attorney? »
Who? »
Is there a court action pending? »
Where? »
*Please explain the entire circumstances surrounding your complaint. Include descriptions of all pertinent documents such as contracts, cancelled checks, warranties, etc.