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Service Request Entry - Consumer Fraud - General

Please complete as much information as possible and click the Review button.

( ** Mandatory fields have red labels. )


Location:  

Supporting Information

PARTICIPANT INFORMATION [CALLER/CONTACT & BUSINESS] IS REQUIRED ON INTAKE!
Which item from the following list best describes the nature of your complaint?
If Other Scams selected, please describe.
When did the incident occur?
Approximately how much did you pay for the services?
What was the method of payment? (select all that apply)
(Multiple answers allowed)
Which of the following document types do you have? (select all that apply)
(Multiple answers allowed)
If Other selected, please describe.
Please Retain All Documents - BACP will follow-up with you.
Input cell # to opt-in for text updates. If opted-in, add cell # to caller info.


Caller / Contact Information
First Name Last Name
Street Address
Address 2
City
E-Mail Address
Contact Type Contact Number   Extension/Comments