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2. Date
3. Name
4. Phone
6. Address
8. City
9. State
10. Zip Code
12. What is your complaint? Include specific details that may be helpful to the Commission.
14. State what effort, if any, you have taken to resolve this matter with the Cable Company including telephone calls, correspondence, and the dates, if such are available.
16. Date called
17. Whom you dealt with
19. What happened and what was the result?
21. Attach any supporting information (i.e., documents, correspondence, or other evidence) to be submitted with your complaint.
23. Are there attachments?

    1. Yes
    2. No
24. Number of pages
25. You are entitled to be present and speak when the Commission hears this Complaint. Please indicate whether you wish to appear.

    1. Yes
    2. No
27. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
29. Electronic Signature
31. The handling of this complaint by the Commission is subject to the procedure of hearing complaints found in the Commission's bylaws. Copies of this procedure are on file and available from the City Attorney's Office. A record of any hearing relating to this complaint will be maintained and opened to public inspection.
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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

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