ADA Complaint Form

Submitted by ichoyle on Wed, 08/28/2024 - 13:17

To submit an Americans with Disabilities Act discrimination complaint, fill out this form.

Indicates required field

Your First and Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone Number

Are you filling this form out for yourself of someone else?

Myself

Someone Else

Person Discriminated Against

Address

City/Town

State/Province

ZIP/Postal Code

Phone Number of Person Being Discriminated Against

Date of Alleged Discrimination

Description of Alleged Discrimination

This question is for testing whether or not you are a human