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Video Services Television Comment/Complaint Form

This form is for comments relating to City of Los Angeles video services TV providers. Please provide detailed information so we can better assist you.

This is a Java Enabled form. You MUST have a Java Browser and have Java and Java Script enabled.

The fields that are in the colorBLUE (and with *) are required fields.

Date:

Video (TV) Provider:

Council Member (if known):

Your Name*

Account Holder's Name*:

Address*:

City:

State

Zip Code*:

Work Number*:

Home Phone*:

Email (optional):

Billing:(concerns or comments regarding your bill):

Technical Service:(concerns or comments regarding your equipment or reception):

Consumer Service:(concerns or comments regarding correspondence with your Video Provider):

Miscellaneous:(any other concerns or comments you may have):