| Date of Report Submission: | 1/23/2023 |
| Submitters IP Address: | 162.158.63.4 |
Complaint Comments:
| Itemized Complaints |
| Consumers Information | |||||
| Name: | **removed for privacy** | ||||
| Address: | **removed for privacy** | ||||
| City: | State: | Zip: | |||
| Daytime Phone: | **removed for privacy** | Evening Phone: | **removed for privacy** | ||
| Repair Facility Information | |||||
| Repair Facility: | |||||
| State Appraiser License: | |||||
| Shop Representative: | Address: | ||||
| City: | State: | Zip: | |||
| Phone: |
| Insurance Information | |||
| Insurance Company: | |||
| Claim Number: | |||
| Insurance Company Representative: | Date of loss: | Appraiser License Number: | |
| Insurance Company Phone: |
| Legislator Information | |||
| Consumer Legislative Representative: | choose one | Consumer Senator: | choose one |
| Repair Facility Legislative Representative: | choose one | Repair Facility Senator: | choose one |
END
PCTG Consumer Complaint Report Record ID#: 1674514492