Consumer Trust Advocacy

Your Information

First Name *

Last Name *

Email *

Phone *

Address *

City *

State *

Zip Code *

Member Business Name *

Service Date(s) *

Contract/Invoice Number

Amount in Dispute ($)

Type of Service Provided *

Have you contacted the member? *

If yes, when did you contact them?

What was their response?

Detailed Description of Complaint *

What outcome are you seeking? *

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By submitting this complaint:

I declare that the information provided is true and accurate to the best of my knowledge
I understand that false claims may result in legal consequences
I authorize Consumer Trust Advocacy to share this information with the member company
I understand that submission of this complaint does not guarantee resolution
I agree to cooperate with any investigation regarding this complaint

I agree to the above declaration *