Please enter as much information as possible about the Company/Website with whom you have a complaint.
Website URL * : http://
Site/Business Name *
Address line1:
Address line2:
City:
State/Province:
Zip/Postal Code (if applicable):
Country:
Phone #:
Not all fields may apply to your complaint. Please fill in only the appropriate fields.
Note: You may choose more than one option
Product or Service Purchased/Rented/Arranged with the company:
Model #:
Order #:
Contract, Account, or Policy #:
Purchase/Contract Agreement Date:
Date Problem first occurred or was
noticed:
Was there a specific Sales Person that you dealt with when you purchased/rented/arranged the product or service:
Title:
Name:
Purchase/Rental/Arrangement Price:
Date you complained to the company/website:
Date:
Did you contact anyone at the Company/Website regarding your complaint?
Name:
Title:
Complaint detail: (max. 100 words)
Enter your DESIRED OUTCOME below. Please keep your description to a summary if possible – the IBSA will contact you if additional details are needed.
YOUR INFORMATION
In order to process the dispute,
the Internet Business Standards Association needs certain personal
information from you.
NOTE: the IBSA
does not process anonymous complaints. Also, the IBSA will only
handle complaints filed by the wrong party. You may not file a
complaint for another person UNLESS it concerns a MINOR.
You must provide a Name, Address, Phone Number,
and E-Mail Address.
If the complaint involves a contract, purchase,
rental, or arrangement between the offending party and your Company
(defined as a company you own, manage, administrate, or work for),
you must also include your Title, and the Name, Address, Phone
Number, and E-Mail Address of the company.
Your Title:
Suffix:
Name* :
Address Line 1* :
Address Line 2:
City* :
State/Province:
Postal Code* :
Country* :
Personal/Home Phone* :
Business Phone:
Fax:
Email* :
Does this complaint involve your Company?
Your Position:
Company Name:
Company Address Line1:
Company Address Line2:
City:
State/Province:
Postal Code:
Country:
Business Phone:
Business Fax:
Email:
Owner/President/Manager of the company:
A brief description of what kind of business the company is involved in:
