Complaint

Please fill out the information requested in this complaint form and submit it. We’ll get back to you as soon as possible.

Personal Information
Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Email*
Representative's Information
If you are a representative for a complainant, please fill out this section.
Name
First Last
Phone
Reason Why Complainant Cannot Complete This Form
Driver's Information
Driver's Name
First Last
Taxicab Number

Located on the Side of Taxicab
License Tag Number

If Not a Taxicab
Date of Incident*
MM slash DD slash YYYY
Time of Incident*

: Hours

Minutes

AM/PM
Location of Incident
Describe Your Complaint in Detail*

Personal Information