CCI
Contract Callers, Inc.
Field Service Complaint / Damage Claim Form
Confidential — internal use only
✉ Submitting to management
Lelliott@contractcallers.com • Jharris@contractcallers.com • Lbohling@contractcallers.com
Form type
Select form type
*
-- Select one --
Complaint
Damage Claim
Please select a form type.
Claim information
Claim reference number
Date reported
*
Select the date reported.
Customer information
Customer name
*
Customer name is required.
Service address
*
Service address is required.
Phone number
Email
Service details
Date of service visit
*
Select the service visit date.
Incident details
Description of incident
*
Describe the incident.
Description of complaint / damage
*
This field is required.
Date became aware
Was customer home?
Yes
No
Unknown
Photos available?
Yes
No
CCI use only
CCI representative
Date
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Lelliott@contractcallers.com • Jharris@contractcallers.com • Lbohling@contractcallers.com