* First Name:

* Last Name:

* Your Registered Phone Number

( -Area Code- 405 580 918 ) - -

Street Address:

City:

Zip:

* County:

-Choose County- Adair Alfalfa Atoka Beaver Beckham Blaine Bryan Caddo Canadian Carter Cherokee Choctaw Cimarron Cleveland Coal Comanche Cotton Craig Creek Custer Delaware Dewey Ellis Garfield Garvin Grady Grant Greer Harmon Harper Haskell Hughes Jackson Jefferson Johnston Kay Kingfisher Kiowa Latimer LeFlore Lincoln Logan Love Major Marshall Mayes McClain McCurtain McIntosh Murray Muskogee Noble Nowata Okfuskee Oklahoma Okmulgee Osage Ottawa Pawnee Payne Pittsburg Pontotoc Pottawatomie Pushmataha Roger Mills Rogers Seminole Sequoyah Stephens Texas Tillman Tulsa Wagoner Washington Washita Woods Woodward

Email Address
(optional)

Date of Complaint

11/21/2009

* Name of Business or Organization

Name of Person you spoke with

Month of Call

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Day of Call

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Time of Call

Product or service being sold

Phone Number that appeared on caller id (if available)

Was Caller ID blocked by the telemarketer?

Yes No

Was the telemarketing message a recorded one?

Yes No

Did you provide an express invitation or permission to the telemarketer to call you?

Yes No

Do you have a past or current business relationship with this company?

Yes No

If this company has called you in the past, did you at that time advise them not to call you again?

Yes No

Did you tell the telemarketer that your phone number is registered on the Oklahoma Don't Call List?

Yes No

Was the telemarketer a member of a non profit group?

Yes No

Was the telemarketer calling on a referral to set an appointment?

Yes No

Did the telemarketer use threatening, intimidating, or profane language?

Yes No

Would you be willing to testify in court regarding this complaint?

Yes No

Please summarize your call