New Jersey Division of Consumer Affairs - Verizon FiOS Consumer Complaint Form

Office of Consumer Protection
I/M/O Verizon FiOS Consumer Complaint Form

Last Name:
First Name:

Address:

City/State/Zip:

Daytime / Work Telephone #:

Evening Telephone #:

Cellular Telephone #:

E-Mail Address:

1. Have you obtained Verizon FiOS service within the past 24 months?
Yes No

2. Did you do so in response to an advertisement or promotion?
Yes No

3. How did you hear about the advertisement or promotion?
Television     Telephone Solicitation
Print Publication     Direct Mailing
Door-to-Door Sales     Other

Describe the date/time during which you heard/saw the advertisement or promotion, as well as the specific television channel or print publication (i.e. newspaper, magazine).

4. **Provide a copy of any promotion or advertisement.

5. What was the specific name of the promotion?

6. What services were included with the promotion?
telephone television internet

7. Was a promotional gift associated with Verizon service you purchased?
Yes No

If yes: What was the gift?

8. Was the promotional gift, if any, a factor in your decision to obtain Verizon services?
Yes No

9. Did you order service from Verizon?
Yes No

If yes: Provide the following:

Date/Time you ordered service:

Method by which you placed the order (i.e. telephone, face-to-face contact):

Services you ordered (check all that apply):
telephone television internet

10. At the time you ordered the Verizon service, were you quoted a price for the services you ordered?
Yes No

If yes: What was the price quoted?

11. If you were provided with a price, were you told that it was "promotional" and/or would be in effect for a limited time?
Yes No

If yes: Were you told the time period during which the price would be in effect?
Yes No

If yes: Provide the time period:

12. Has Verizon honored the price quoted to you?
Yes No

If no: What price has Verizon charged you?

** Provide a copy of a billing statement.

13. If you have been charged a different price for service, have you complained to Verizon?
Yes No

** If yes: Describe the date/time of each contact with Verizon. Provide any relevant documents.

14. After you ordered the Verizon service, did you receive a confirmation letter?
Yes No

If yes: Did the letter include any instructions as to how to obtain the promotional gift, including any authorization number?
Yes No

** If yes: Describe the instructions or provide a copy of the letter.

15. Did you follow the instructions to obtain the promotional gift?
Yes No

** If yes: Describe your actions, and include copies of any relevant documents.

16. Did you receive a copy of a signed agreement or contract concerning the services you were to receive from Verizon?
Yes No

** If yes: Provide a copy of the contract or agreement.

17. Did you receive the promotional gift?
Yes No

If yes: Provide the following:
- Date/Time you obtained the promotional gift:
- Was the promotional gift in good working order?
  Yes No
- ** If no : Describe your actions, and include copies of any relevant documents.

18. If you did not receive the promotional gift, did you have any contact with Verizon to attempt to obtain the gift?
Yes No

** If yes: Describe the date/time of each contact with Verizon. Provide any relevant documents.

19. Was any installation necessary for your Verizon service?
Yes No

** If yes: Describe the date/time of the installation, as well as the work done. Provide any relevant documents.

If yes: Was the installation performed by a Verizon employee?
Yes No

20. Was there any damage to your property during installation?
Yes No

** If yes: Describe the extent of the damage. Provide any relevant documents.

21. If there was damage to your property, did you contact Verizon?
Yes No

** If yes: Describe the date/time of each contact with Verizon. Provide any relevant documents.

22. Other than for ordering service, have you had contact with Verizon's Customer Service?
Yes No

** If yes: Describe the date/time of each contact and the nature of your contact. Provide any relevant documents.

23. Have you submitted a formal complaint to Verizon?
Yes No

** If yes: Describe the nature of your complaint.

24. Has Verizon resolved your complaint?
Yes No

** If yes: : Describe the resolution (i.e. refund):

25. Please indicate which company or companies provided services to your home BEFORE you switched to Verizon:

Cable Television:
Internet:
Telephone

26. Please indicate which company or companies CURRENTLY provide services to your home:

Cable Television:
Internet:
Telephone

27. If you currently have any Verizon service, are you satisfied with the service?
Yes No

** If no : Describe any problems or issues with the service.

28. To the extent not otherwise requested, provide copies of any other documents related to your transaction with Verizon.?

29. Please provide any additional comments:

30. Please check ONE of the boxes below:

	I, the undersigned, DO give permission to Verizon, Verizon New Jersey, and related entities to provide all documents in Verizon's possession concerning the above-referenced account, including, but not limited to bills, billing details and customer service notes, to the New Jersey Division of Consumer Affairs. This information will be used to investigate my consumer complaint against Verizon.

	I, the undersigned, DO NOT give permission to Verizon, Verizon New Jersey, and related entities to provide all documents in Verizon's possession concerning the above-referenced account, including, but not limited to bills, billing details and customer service notes, to the New Jersey Division of Consumer Affairs. This information will be used to investigate my consumer complaint against Verizon.

I CERTIFY THAT THE FOREGOING STATEMENTS MADE BY ME ARE TRUE. I AM AWARE THAT IF ANY OF THE FOREGOING STATEMENTS MADE BY ME ARE WILLFULLY FALSE, I AM SUBJECT TO PUNISHMENT.

** Please send all documents from above to:
Ray Yee
P.O. Box 45025
Newark, N.J. 07101

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Copyright © State of New Jersey, 1996-2007 This page is maintained by DCA. Comments/Questions: email Page last modified: