MADISON CABLE BOARD
215 MARTIN LUTHER KING JR., BLVD, Rm. 210
MADISON, WI 53703



CITY OF MADISON CABLE COMPLAINT FORM

Name:_________________________________________________________________

Address:________________________________________________________________
_______________________________________________________________________

Phone number: Daytime ( ) ____________ Evenings ( )______________
Today's date:_____/______/______

Date problem occurred: ______/______/______

Problem: (please describe in detail and include copies of relevant information; attach additional pages if more room is needed):
_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Ideally, how would you like to see your problem resolved? (Example: I'd like my money back, or the repair done as soon as possible, etc.) __________________________________________________________________________

__________________________________________________________________________

Send this complaint to:
Cable TV Coordinator
215 Martin Luther King Blvd, Room 210
Madison, WI 53703

For office use only:
Complaint code: _________________________

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