Pet Dealer Complaint Form

Establishment Information

Establishment Owner

Establishment Name

Establishment Street Address

City

State

Zip Code

County

Complainant Information

Date Complaint Submitted

Complainant Full Name

Complainant Address

City

State

Zip Code

Contact Phone Number

Extension

Email Address

Please indicate whether your complaint is related to a purchase or an observation.

Purchase

Observation

Date

Breed

Sex

Description of Complaint