Contact 6

PLEASE NOTE:

This form must be filled out professionally and use upper case and lower case correctly, since it generates the letter we will be sending to the company on your behalf.

WARNING: When completing your complaint, DO NOT use commas. The system does not recognize the symbol and will cut off your complaint.

Full Name

First NameLast Name

Phone Number

Area CodePhone Number

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Company Name

Company Contact

Company Number

Area CodePhone Number

Company E-mail

Company Address

Company Street Address

Company Street Address Line 2

Company CityCompany State / Province

Co Postal / Zip CodeCompany Country

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I agree to do an on-camera interview should Contact 6 pursue my story. *By answering "Yes" Contact 6 will be better able to help resolve your complaint

Please explain your problem accurately

What are you seeking from this company?

Account #:

If applicable. If not, type N/A

Attach copies of receipts, warranties or other important documents

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