Grievance and Complaints Form
This form is for the sole purpose of submitting a grievance or complaint about an experience that you had with Chainless Change.

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First Name *
Last Name *
Phone Number *
Email *
Street Address *
City *
State *
Zip Code *
If this grievance or complaint is about a specific person, please provide their name.
How are you connected to Chainless Change? *
If you selected other above, please describe your connection to Chainless Change.
Have you previously discussed this situation with a Chainless Change team member? *
If you answered yes to the question above, please provide the name of the person that you previously spoke with?
Please tell us a bit about the experience that you would like to report. *
Do you have any other questions, thoughts or concerns that we should know about? If so, please provide those details below.
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