Lewis County Transit Customer Service Form

CUSTOMER SERVICE FORM
Date of Incident*

MonthDayYear
Date
Time *
A.M.P.M.
Route *
Employee's Name (if known)
Location*
Written Explanation of Complaint:*
Please be as specific as possible.
Name*
I declare, subject to penalties of perjury, that all the statements made in this complaint have been examined by me and to the best of my knowledge and belief are true and correct.
Signature*

Clear
Phone*
Please direct this completed form to the Lewis County Transit Human Resources Director
Should be Empty: