Free Small Businesses Complaint Form

Please complete all sections to ensure your complaint is addressed effectively.
Personal Information
Name
Address
Phone Number
Complaint Details
Date of Incident
Name of Small Business
Business Address or Location (if applicable)
Staff Member(s) Involved (if known)
Name(s) | Contact Number |
|---|---|
Nature of Complaint
Check all that apply:
Poor Customer Service
Product/Service Quality Issue
Billing or Payment Dispute
Delayed Delivery or Service
Misrepresentation or False Advertising
Description of Incident
Provide a detailed account of the issue, including dates, times, and relevant interactions. Attach additional pages if necessary.
Action Taken
Have you reported this issue to anyone else?
If yes, please specify:
Desired Resolution
Describe how you would like this to be resolved.
Supporting Document
Upload a file to support the complaint.
By signing below, I affirm that the information provided is accurate to the best of my knowledge.
Name:
Signed:
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