Airline Complaint Form

Section 1: Your Information

Salutation

Select

Your Name*

Date of Birth

Day Time Phone Number*

Phone

Email Address*

Your Street Address*

City*

State*

Zip Code*

Drivers License Number

Drivers License State

Other Contact Info

Section 2: Statistical Information (Optional)

Your Age

Under 30

31-59

60-79

over the age of 80

Military/Veteran

Active Duty

Veteran

Section 3: Complaint Details

Name of Airline*

Date of Flight*

Flight Number*

Departure City*

Arrival City*

Describe the nature of your complaint:*

Have you complained to the airline?*

Yes

What was the response?

Have you contacted another agency about this complaint?*

Yes

Please provide the name of the agency:*

Have you retained an attorney?

Yes

Is any legal action pending?

Yes

Identify the jurisdiction of the legal action:*

Did you sign any documents?*

If yes, please attach copies of documents below.

Yes

Did you pay money for a service?*

Yes

Actual amount paid

Method of Payment

Please attach copies of statements, checks, etc. below.

Cash

Check

Credit Card

Other

Please upload any supporting documents.

File Upload

Drag and drop files here or

Section 4: Resolution Requested

Describe what you would consider a reasonable resolution to your complaint:

Section 5: Acknowledgement

BY FILING THIS COMPLAINT, I UNDERSTAND THAT:

A copy of this complaint will be sent to the company or individual that this complaint has been filed against or the complaint will be referred to the appropriate agency.

Oklahoma law prohibits us from giving legal advice or opinions or acting as your personal attorney. If you desire legal advice, we suggest you consider contacting a private attorney to discuss your complaint.

The above statements are true and accurate to the best of my knowledge.

I Agree*

Signed

Dated

Send me a copy of my responses

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