ADRC Complaint Form

If you choose to contact us via email, please be aware that your email is NOT encrypted.

That means there is a possibility that the information you transmit to us may be viewed by unauthorized persons during transmission.
If you are including personal information in your email, you may wish to contact us via telephone.

To help us ensure that we understand your complaint and can respond promptly, please complete and submit this form.

Your Contact Information

Name*

Address*

City, State & Zip*

Phone*

Email*

If you are submitting this form on behalf of someone else...

Name of Customer

Please Describe Your Complaint

Be as specific as you can and include any names or dates, as this may help resolve your complaint.

Complaint*

How would you like to see your complaint resolved?

Resolution Requested*

Please type these letters: