Orion Community Cable Communications Commission
37 East Flint Street, Lake Orion, Michigan 48362
Phone: (248) 693-7420 Fax: (248) 693-9686
Cable Television Subscriber Complaint Form

Please complete to the double line and return to the Cable Commission
at the above address or fax number.
Attach another sheet or use the back of this form if more room is needed.

Name ____________________________________________ Phone _______________

Address ________________________________________________________________

Nature of complaint - please be specific ________________________________________

______________________________________________________________________

______________________________________________________________________

Have you contacted the cable company regarding this issue? _______________________

If yes, please explain how and when the cable company was contacted, and their response.

____________________________________________________________________

______________________________________________________________________

How would you like this issue to be resolved?

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________
______________________________________________________________________
To be completed by Cable Commission:
Date received ____________________ Resolution ______________________________

______________________________________________________________________

____________________________________________ Date resolved: ______________

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