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First Name:
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Last Name:
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Address1:
Contact Phone #:
Address2:
Email:
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City:
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Country:
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Business Information
Is business located in the U.S. Virgin Islands?
Yes
No
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Street1:
Street2:
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City:
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Country:
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State:
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Zip:
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Business Name:
Business Address:
Person Name:
Product/Service Information
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Receipt #
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Complaint Information
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Complaint Description
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Did you try to resolve the issue with the business/individual?
Yes
No
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Who did you complain to?
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What was their response?
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How do you want this complaint resolved?
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Did you sign any documents/agreements/contracts?
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