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First Name

Last Name

Your Business Name

What is your Mc or DOT

Your Contact Number

The name of the Freight Broker Company You Are Filing A Complaint

Broker Company MC#

The First Last Name Of The Freight Agent With Broker CompanyAgent

Contact Phone Number Of Freight Agent

Freight Agent Email

Describe In Detail Your Complaint. This will be added to our website for public viewing

Describe What You Are Looking For As An Outcome Of This Complaint

Rate Confirmaton PDF

Bill Of Lading PDF

Additional Evidence PDF

Picture Evidence (Image)

Proof Of Delivery PDF

Email Evidence PDF

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