Rider Complaint Form
Rider Information
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Preferred Contact Method
Please Select
Phone
Email
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Trip Information
Date of Trip
-
Month
-
Day
Year
Date
Pick-up Location
Drop-off Location
Driver Name (if known)
Vehicle Make/Model/Color (if known)
Trip ID (if available)
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Nature of Complaint
Please select the category that best describes your complaint:
Safety concern
Driver behavior
Vehicle condition
Discrimination
Harassment
Payment/fare issue
Pickup or drop-off issue
App/technical issue
Other
Description of Incident: Please describe what happened in as much detail as possible:(Include time, location, events, and any supporting information.)
Evidence or Attachments: If you have screenshots, photos, receipts, or other evidence, please list or attach them:
Browse Files
Drag and drop files here
Choose a file
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of
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Desired Resolution
What would you like DCC to do to resolve this issue?
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Consent
I certify that the information provided is accurate to the best of my knowledge.
Signature
Date
-
Month
-
Day
Year
Date
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Should be Empty: