State of Tennessee - Alarm Systems Contractors Board

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Alarm Systems Contractors Board

The Great Seal of the State of Tennessee
Department Of Commerce and Insurance
Division of Regulatory Boards
Alarm Systems Contractors Board
500 James Robertson Parkway, 2nd Floor
Nashville, Tennessee 37243
(615) 741-9771
Fax:(615) 532-2965

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On-Line Consumer Complaint Form

(* denotes required field)

Date Filed

*Complainant
*Mailing Address
*City, State, Zip
*Telephone Number
Email Address
Are you licensed by this State Board? Yes No

If YES, give license Number

*Respondent(s)
Street Address
*City, State, Zip
Telephone Number

Please provide the following information.

Name of Your Employer

Employer's Address

Street Address

City

State

Zip

Your Business Phone

NOTE: Pursuant to TCA Title 47, Chapter 18, the Tennessee Consumer Protection Act, you may want to file a complaint with the Division of Consumer Affairs, 5th Floor, 500 James Robertson Parkway, Nashville, Tennessee 37243. (615-741-4737) or (800-342-8385)

Form IN-0759 (Rev. 3/88)

*BASIS FOR YOUR COMPLAINT

Give a complete statement of the facts, with dates. You may also be asked to provide originals of all documents that will support your allegations. You should retain copies.

Other person(s) with firsthand knowledge of your complaint:

Name

Address

Mailing Address

City

State

Zip

Home Phone

Business Phone

Name

Address

Mailing Address

City

State

Zip

Home Phone

Business Phone

Have you consulted an attorney? Yes No
If YES, please provide the following:

Name

Address

Street Address

City

State

Zip

Phone

By submitting this information, I hereby attest to the accuracy or truthfulness of the content. I agree.

*Signature (Please type your name) *Date

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