C.O.P.S Complaint Form

Consumer Information:

I wish to remain anonymous: 

Yes No
Title Mr. Ms. Mrs.
Last Name 

First Name

Address 

City 

State/Province

Zip Code / Postal Code

For U.S. zip codes, enter five digits only -- do not use Zip +4. 
Country  United States    Canada 
Other: please enter country name 

Phone # (day)

   Extension   

Phone # (eve.)

Fax Number 

EMAIL 


Information About The Business That You Are Filing A Complaint Against:

 

Business Name:

URL:e.g. (http://www.???.com)

Please be as specific as
possible about the problem or complaint and the actions you would like the business to take to resolve it. To be sure that your message transmits correctly, please press "enter" to start a new line when your cursor nears the edge of the input box. Thanks.

 

 

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