Home Improvement Service Complaint Form >PDF version<

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:"Click" Arrow for Choices
Subject of Your Complaint:"Click" Arrow for Choices
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?"Click" Arrow for Choices
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?"Click" Arrow for Choices
Did You File a Dispute with the BBB?"Click" Arrow for Choices
Did You File a Dispute with the BBB More Than 45 Days Ago?"Click" Arrow for Choices
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.)