Date/Time - Use Calendar *
Mr/Ms./Mrs.
Mr.Mrs.Ms.MasterProf.Dr.GenRepSenSt
First Name *
Middle Name
Last Name*
Street Address*
Address Line 2
City*
State/Province/Region*
Postal/Zip code
Country*
AnegadaBritish Virgin IslandsJost Van DykeTortolaVirgin Gorda
Mobile Phone*
Residential Phone
Business Phone
Primary Email*
Alternate Email
Name of Service Provider*
—Please choose an option—BVI Cable TVCCTDigicelFLOW
Service Number*
Nature of Complaint*
Quality of ServiceBilling and RatesTerms of UseMarketingEquipment
Detail description of Complaint*
Date on which problem occurred*
Have you filed a complaint with the company before contacting the commission?*YesNo
If yes, who was the contact person(s)?
Any action taken by a company should be described in detail
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