New Complaint

Customer Complaint Form

Personal Information

FIRST NAME

*

LAST NAME

*

Contact Number

*

PREFERRED LANGUAGE OF COMMUNICATION

EMAIL

**

DC RESIDENCE

ADDRESS

*

APT/SUITE

*

CITY

*

STREET

*

ZIP CODE

*

COUNTRY

*

STATE

*

QUADRANT

*

WARD

*

Complaint Details

UTILITY SECTOR

UTILITY COMPANY NAME

ACCOUNT NUMBER

*

TYPE YOUR COMPLAINT HERE (Maximum character size is 5000)

*

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