Home Improvement Service Complaint Form >
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NOTE: THIS FORM IS CURRENTLY UNDER REVISION WITH OUR PROGRAM ADMINISTRATOR (Your comments are welcome).
Please >
Read
< before filling out this form
How Do We Reach You?
First Name:
Last Name:
Mailing Address:
City:
Postal Code:
E-Mail Address:
Home Phone:
(
)
(Area Code)(Phone Number)
(Numbers Only)
Work Phone:
(
)
Ext.
(Area Code)(Phone Number)(Extension)
(Numbers Only)
Information about your complaint...
Do you have a
preferred person
to resolve this dispute:
No Preference
Roger Ward
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Subject of Your Complaint:
Project Not Started
Project Not Completed
Materials Not Delivered
Poor Workmanship
Overcharged for Services / Products
See explanation below
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Name of Company You Are Complaining About:
Check If Company Name Is Unknown:
Street Address:
City:
Postal Code:
Company Web Site:
Company E-Mail Address:
Phone Number:
(
)
Ext.
(Area Code)(Phone Number)(Extension)
(Numbers Only)
What was the original means of contact?
E-mail
Fax
In Person
Internet (Other)
Internet Web Site
Mail
Phone
Print
TV/Radio
Unknown
Wireless
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How Much Did the Company Ask You to Pay?
(Numbers Only)
How Much Did You Actually Pay the Company?
(Numbers Only)
How Did You Pay the Company?
Credit Card
Bank Account Debit
Money Order
Cash
Cash Advance
Cashier's Cheque
Certified Cheque
Personal Cheque
Postal Money Order
Wire Transfer
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Did You File a Dispute with the BBB?
Yes
No
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Did You File a Dispute with the BBB More Than 45 Days Ago?
Yes
No
Do Not Know
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COMPANY REPRESENTATIVE
First Name:
Last Name:
Date Last Contacted :
(MM/DD/YYYY)
Explain Your Problem: (Please limit your complaint to 2000 characters.)
What have you done to resolve this conflict: (Please limit your complaint to 2000 characters.)