Better Business Bureau serving Alaska, Oregon & Western Washington
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COMPLAINT FORM
IMPORTANT: COMPLETE ALL FOUR SECTIONS
1
COMPANY NAME COMPANY ADDRESS, CITY, STATE, ZIP
CONSUMER NAME CONSUMER ADDRESS, CITY, STATE, ZIP
COMPANY EMAIL COMPANY PHONE # DATE PROBLEM OCCURRED
CONSUMER EMAIL CONSUMER HOME PHONE # DATE(S) YOU COMPLAINED TO CO. BRAND NAME CONSUMER WORK PHONE # TO WHOM: MODEL NAME OR NO.
2
PRODUCT/SERVICE ORDER, CONTRACT, ACCOUNT # (if applicable) AMOUNT INVOLVED $:
IF ADVERTISING INVOLVED, WHERE/WHEN NAME OF SALESPERSON
3
WHAT IS YOUR COMPLAINT? If you have any relevant documents such as contracts, receipts, or cancelled checks, please include a copy.
4
WHAT IS THE EXACT ADJUSTMENT YOU ARE REQUESTING FROM THE COMPANY?
TO THE CUSTOMER: MAIL THIS COMPLETED AND SIGNED FORM BACK TO THE BBB. YOUR SIGNATURE GIVES THE BBB PERMISSION TO RELEASE THIS INFORMATION TO REGULATORY
AUTHORITIES AS NECESSARY
CUSTOMER SIGNATURE
DATE
Alaska: (907) 532-0704 Oregon: (503) 212-3022 Washington: (206) 431-2222 or (253) 830-2924 Fax: (206) 431-2200
BBB serving Alaska, Oregon & Western Washington P.O. Box 1000, DuPont, WA 98327
COMPLAINT INSTRUCTIONS
Before completing this form, please make a sincere effort to settle your complaint with the company by contacting the owner, manager, or someone in authority. Complete this form in a professional manner. Make sure your statement is clear and factual but be as brief as possible. 1. Complete form legibly 2. Do not make threats or accusations 3. Give the complete mailing address of the company 4. Limit your remarks to the space provided on the form, if possible 5. Enclose two copies of any additional information - DO NOT send any original documents 6. PLEASE SIGN FORM The Better Business Bureau recommends filing your complaint online at www.bbb.org. BBB Survey Please complete the following survey. The Better Business Bureau serving Alaska, Oregon & Western Washington is consistently looking for ways to better serve our communities. The information collected in this survey will help us meet this goal. We thank you in advance for your participation. Gender: Male Age: Under 25 65+ Female 25-35 35-55 55-65
Annual Household Income: Less than $25,000 $25,000 - $49,999 Education Level: High School or equivalent Some College Bachelor’s Degree Post-graduate Degree
$50,000 - $99,999
$100,000+
Reason for contacting the BBB: Inquire on a company Inquire on a charity File a complaint General question/seeking information Other ________________
Location Zip Code ___________ County _________________________ State _______________ How Did You Hear About Us? Radio Internet Family/Friend Television Billboard Consumer Guide Other
Comments:
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Privacy Statement: The information provided in this survey will be compiled for use by the Better Business Bureau serving Alaska, Oregon & Western Washington. We respect your right to privacy and will not collect or disclose personal identifying information.