Free Utilities Complaint Form Template
Utilities Complaint Form
Please complete all sections for timely resolution of your complaint.
Personal Information
Name
Address
Phone Number
Account/Service Number (if applicable)
Complaint Details
Date of Incident
Utility Service Involved
Check one:
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Electricity
-
Water
-
Gas
-
Waste Management
-
Location of Issue (if different from above)
Details of Staff Interaction (if applicable)
Nature of Complaint
Check all that apply:
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Service Interruption or Outage
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Billing or Payment Dispute
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Poor Service Quality
-
Maintenance or Repair Issue
-
Unprofessional Staff Behavior
Description of Incident
Provide a detailed account of the issue, including relevant dates, times, and service details. Attach additional pages if necessary.
Action Taken
Have you reported this issue to anyone else?
If yes, please specify:
Desired Resolution
Describe how you would like this to be resolved.
Supporting Document
Upload a file to support the complaint.
By signing below, I affirm that the information provided is accurate to the best of my knowledge.
Name:
Signed:
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