Federal Communications Commission - Slamming Complaint Form 501

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FCC Form 501

Federal Communications Commission
Slamming Complaint Form 501
For Slamming Complaints Only

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In order for your Slamming complaint to be processed you MUST attach a copy of the phone bill(s) or a welcome letter/package, showing the name of the alleged unauthorized phone company and the disputed charges. The preferred file format for this copy is a 200dpi black and white (not grayscale) multi-page TIF file. All scanning software should support this standard format. The upload allows for a single file to be attached to a 501 complaint; the TIF format allows for multiple pages in a single file.

In order to process your complaint, the Commission needs the information marked below with an asterisk (*). Information not marked with an asterisk (*), if available, is also helpful.

1. Today's Date:	May 25, 2013
*2.First Name:
3. Middle Initial:
*4. Last Name:
*5. Street Address/Post Office Box Number:
*6. Zip Code:
*7. City:
*8. State:
If your state is not selectable on this form, or the typed zip code is reset to blank, go to http://www.fcc.gov/encyclopedia/slamming for information on how to file your complaint with your state Public Utilities Commission.
*9. Are you filing on behalf of a family member, client, company or organization?	Yes No

*10. Is this complaint about a (check one)
Residential Home Telephone Service	Business (Commercial) Telephone Service
*11. List all Telephone Numbers (Maximum of 6) -- including Area Codes, that you claim were slammed:
*11a. () -	11b. () -
11c. () -	11d. () -
11e. () -	11f. () -
*12. Your Daytime Telephone Number: () - Extension:
*13. Name of your authorized LOCAL telephone service provider:

*14. Name of your authorized LONG DISTANCE telephone service provider that the service was changed from:

*15. Name of the company that you are complaining about:

16. Are you back with your authorized telephone company?	Yes No
17. Amount of charges you are disputing:
18. Have you paid any of the disputed charges?	Yes No
19. Did the billing company adjust or refund the disputed charges?	Yes No
20. If yes, how much was the adjustment or refund?
*21. Briefly explain what happened. Please include dates whenever possible.

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01.01.03 April 12, 2011