Driver Complaint Form
Driver Information
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred contact method
Please Select
Email
Phone
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Trip Information
Date of Trip
-
Month
-
Day
Year
Date
Pick-up Location:
Drop-off Location:
Rider 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
Rider behavior
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: