COMPLAINT FORM

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=82 style=" border-bottom: 2px solid #006600;" BGCOLOR="#006600" TEXT="#F7F7FF" bgproperties="fixed" background="0418dfe1dwnpjk.jpg"> <div> <FONT SIZE="5" COLOR="#000000" FACE="Arial" ><B>Roscommon Township</B></FONT><B>     </B><B>|</B><B>     </B><A HREF="index.htm" TARGET="_top" TITLE="Roscommon Township"><B>home</B></A></div> <div>            <A HREF="id39.htm" TARGET="_top" TITLE="References">References</A>                     <A HREF="id38.htm" TARGET="_top" TITLE="Contact Us">Contact Us</A>               <A HREF="id20.htm" TARGET="_top" TITLE="Special Boards/Services">Special Boards/Services</A>                 <A HREF="id40.htm" TARGET="_top" TITLE="State/County Links">State/County Links</A></div> <bR> <bR> <bR> <div> </div> </td> </tr><tr> <td valign="top" height=398 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="0418dfc3.jpg"> <div> <I>COMPLAINT FORM</I></div> <bR> <div> <TABLE BORDER="0" CELLPADDING="2" CELLSPACING="1" WIDTH="658" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 19 ><NOBR><div> ________________________________________</div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> _____________________________</div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> __________________________________________</div> </NOBR></tD> </tR> </TABLE></div> <div>           Date                      Time of Day                                              Staff Name</div> <bR> <div> <TABLE BORDER="0" CELLPADDING="2" CELLSPACING="1" WIDTH="663" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 19 ><NOBR><div> ___________________________________________________________________ </div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> __________________________</div> </NOBR></tD> </tR> </TABLE></div> <div>                                      Customer's Name                                                       Phone #</div> <bR> <div> <TABLE BORDER="0" CELLPADDING="2" CELLSPACING="1" WIDTH="665" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 19 ><NOBR><div> ________________________________________________       </div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> __________________________</div> </NOBR></tD> </tR> </TABLE></div> <div>                                                City                                                                      Zip Code</div> <bR> <div> CUSTOMER CONCERN</div> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="709" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 38 WIDTH="17"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="38" ALIGN="bottom" WIDTH="17" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="307"><div> Rates (Cost for service)</div> </tD> <tD VALIGN=TOP WIDTH="16"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="38" ALIGN="bottom" WIDTH="16" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="336"><div> Construction (Damage to property, digging in yard, dangling wires, cut lines, lack of notice)</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 38 WIDTH="17"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="38" ALIGN="bottom" WIDTH="17" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="307"><div> Line Extension (Can't get service extended to home because area isn't serviced yet)</div> </tD> <tD VALIGN=TOP WIDTH="16"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="38" ALIGN="bottom" WIDTH="16" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="336"><div> Billing (Late charge, overcharge, wrong charge, difficulty reading bill)</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 57 WIDTH="17"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="57" ALIGN="bottom" WIDTH="17" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="307"><div> Technical problems (Outages, poor reception, decoder box, remote control, VCR incompatibility)</div> </tD> <tD VALIGN=TOP WIDTH="16"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="57" ALIGN="bottom" WIDTH="16" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="336"><div> Inquiry (Request for general information on city policy, company procedures.</div> <bR> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 57 WIDTH="17"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="57" ALIGN="bottom" WIDTH="17" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="307"><div> Customer service (Missed appointments discourteous employees, lack of responsiveness)</div> </tD> <tD VALIGN=TOP WIDTH="16"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="57" ALIGN="bottom" WIDTH="16" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="336"><div> Programming (Don't like existing programs, want programs/channels not offered)</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 38 WIDTH="17"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="38" ALIGN="bottom" WIDTH="17" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="307"><div> Phone service (Delayed connection, disconnections, abandoned calls)</div> </tD> <tD VALIGN=TOP WIDTH="16"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="38" ALIGN="bottom" WIDTH="16" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="336"><div> Other (Not related to any of the types mentioned above)</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="17"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="17" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="307"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="307" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="16"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="16" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="336"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="336" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="714" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="702"><div> Explanations:</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="702"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="702" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="702"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="702" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="702"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="702" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="702"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="702" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="702"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="702" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="702"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="702" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div> Date Resolved:   ___________________Resolved by______________________________________</div> <div> Resolution:_______________________________________________________________________</div> <div> ________________________________________________________________________________</div> <bR> <div> <A HREF="mailto:rosctwp@voyager.net" TARGET="_top" TITLE="mailto:rosctwp@voyager.net">mailto:rosctwp@voyager.net</A></div> <bR> <bR> <bR> <bR> <bR> <div>                                                                         </div> </td> </tr></table></body>