Free Letters of Complaint
Adjustment Form Letter of Complaint

Adjustment Form

Name of Complainant                                         
Date of Complaint                                         
Name and Location of Store/Company                                         
Name of Responder                                         
Date of Response                                         
Adjustment Requested                                         
Approved Adjustments                                         
Rejected Adjustments                                         
Effective Date                                         
Refund/Compensation Amount                                         
Name of Recipient                                         
Phone Number of Recipient                                         
Address of Recipient                                         
Received and Recorded by                                         

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