Approved by OMB 3060-0874 (Est. average burden per response is 15 minutes).
Privacy Statement
Fields marked with * are required. The submit button will not be active until all required fields are completed.
Please provide the details of your issue. Do not enter personal information like name, address, phone or account number. There are places to enter that information below, if applicable.
Please select the issue that best describes your complaint.
Select a sub issue that best describes your situation.
If yes, describe in the description field what personal information has been accessed, obtained or used and how you discovered it.
If yes, attach or describe the notice, include the date you received the notice and what it contained.
Please indicate the type of property, goods, or services that were advertised.
Please select how you receive your phone service.
Please enter the phone number in the following format 555-555-5555
Are you a service provider filing on behalf of a customer?
You can click in the field to use a calendar to select a date. If you enter the date it must be in the following format: January 1, 2015
Examples of the time format are: 1:00 pm or 2:45 p.m. or 8:51 P.M.
Please provide the transmission date in the header line of the fax. You can click in the field to use a calendar to select a date. If you enter the date it must be in the following format: January 1, 2015
Have you or anyone else in your household or business given the fax advertiser permission to fax?
Have you or anyone else in your household or business done any business (including an inquiry or application) with the fax advertiser?
A copy of the fax must be attached to your submission. Please check the box to confirm that you are attaching a copy of the fax.
Please indicate the type of call or message received.
Please enter the name received on the Caller ID.
Only provide information received during the call/message itself, and not information received through Caller ID.
Only provide information received during the call/message itself, and not information received through caller ID. Please enter the phone number in the following format 555-555-5555
Please select the company that is the subject of your complaint. If the company is not listed, select "other" and provide the name of the company.
If you selected other from the list of Company Names, please provide the company name.
Please select the other company that is the subject of your complaint in instances including number portability and rural call completion. If the company name is not listed in the drop down, select "other" from the list and provide the name of the other company.
Please enter your account number, if applicable.
Please check the box to confirm that the phone is a wireline phone. Only wireline phones are subject to the FCC's slamming rules. Wireless phones are not.
A copy of your phone bill must be attached to your submission. Please check the box to confirm that you are attaching a copy of your phone bill.
If your state is not listed in the state field, you need to file a complaint with your state Public Utilities Commission. Please go to http://www.fcc.gov/encyclopedia/slamming for information on how to file your complaint with your state Public Utilities Commission.
Please indicate if your phone number is a residential or business telephone.
Please provide the name of your authorized local telephone provider
Please provide the name of your authorized long distance telephone service provider that the service was changed from.
Please indicate whether you are back with your authorized telephone company
Please indicate if any of the disputed charges were paid.
Please indicate if the disputed charges were adjusted or refunded.
Please enter two decimal places
Please enter amount to two decimals. For example, 10.25.
Please provide any more information you would like to share about this call or your interactions with this company.
If you have a PO Box, please enter it in this field.
The format of the zip code can be: 20850 or 20850-1234
Please indicate whether you are filing this on behalf of someone else.
I declare under penalty of perjury that (1) I am over 18 years old, (2) I am authorized to make decisions regarding the telephone number listed below, and (3) the information I have provided today on this Federal Communications Commission electronic form is, to the best of my knowledge, true and correct.