North Carolina Utilities Commission Public Staff – Consumer Services Division 4326 Mail Service Center Raleigh, NC 27699-4326 Tel: (866) 380-9816; (919) 733-9277 Fax: (919) 733-4744; consumer.services@psncuc.nc.gov COMPLAINT FORM If you have not contacted your utility company regarding this complaint, please do so as the first step. If you have already contacted your utility company and are not satisfied with its resolution, please fill out this form and mail it to the address above. For immediate assistance regarding the termination of your utility service, please call (919) 733-9277, Monday through Friday, 8:00 a.m. to 5:00 p.m. Utility Company ________________________________________________________ Customer’s Name _______________________________________________________ Street Address _________________________________________________________ City _____________________________________ State ______ Zip______________ Home Phone # _______________________ Work Phone # ___________________ E-mail Address __________________________________________________________ For Telephone Complaints Only – Please provide the telephone number with which are experiencing a problem: ________________________ 1. Please describe your complaint: _____________________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________________ 2. What was the company’s response: ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________
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Printed Name: ___________________________________________________________
Signature: __________________________________ Date: ____________________
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