Employment application
1 Complaint Form 1. Before you submit the complaint form, please make sure you reach out to the utility you have the dispute with to allow them to rectify the problem. 2. Submit a copy of all letters, receipts, or any other documentation that may support your claim. Please note that as a part of the complaint handling process, the Public Services Commission (PSC) may forward a copy of this complaint to the utility complained against. ____ St. Croix ____ St. Thomas ____ St. John Customer Information Customer Name (as indicated on account): Date: Name of Authorized Complainant if different than above: Physical Address: Location of the complaint Apartment/Unit # City State ZIP Code Phone: Email Is this service for your home or business: Name of Utility: Account Number: Mailing Address: Complaint Received Via: (In person, Phone, Email) Briefly describe your complaint. Indicate specific details, i.e., dates, names, and occurrences. …
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1 Complaint Form 1. Before you submit the complaint form, please make sure you reach out to the utility you have the dispute with to allow them to rectify the problem. 2. Submit a copy of all letters, receipts, or any other documentation that may support your claim. Please note that as a part of the complaint handling process, the Public Services Commission (PSC) may forward a copy of this complaint to the utility complained against. ____ St. Croix ____ St. Thomas ____ St. John Customer Information Customer Name (as indicated on account): Date: Name of Authorized Complainant if different than above: Physical Address: Location of the complaint Apartment/Unit # City State ZIP Code Phone: Email Is this service for your home or business: Name of Utility: Account Number: Mailing Address: Complaint Received Via: (In person, Phone, Email) Briefly describe your complaint. Indicate specific details, i.e., dates, names, and occurrences. By submitting this complaint, you are stating that the information contained in the complaint and any attachments or exhibits is true and accurate to the best of your knowledge. GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS FOR OFFICIAL USE ONLY PSC COMPLAINT NO.: __________________________ RECEIVED BY: ________________________________ DATE RECEIVED: ______________________________ REFERRED TO: ______________ DATE: ___________