example:  new complaint form

Heading (one sentence description of your complaint) 

Name of Company you want to complain about 

company's email address (if you know it)  

Compan's Web Page address (if you know it) 

Tpye of complaint  Poor Services Rude Employee Bait and Switch Poor Quality Broken Promises Price Unfairly Changed other

Has the problem been resolved to your satifsfaction  

Your name (real names only please)    

Your e-mail adddress  

Detail of your complaints (1000 words maximum)

Upload Pictures  

Upload file as proof. 

How much does it cost? (this part will change according to setting in admin panel:)  (if admin is set free, then it will see FREE )
There is a one-time cost of $xxxx per complaint response (in US dollars). We accept Visa, Mastercard, American Express and Discover cards.

The fine print.
By clicking on the proceed button you agree to the following:
1) Your complaint response contains only truthful information.
2) Your complaint response relates to your own personal experiences (i.e. you can't post a complaint response for someone else).
3) Your complaint response does not libel or slander any person or company (i.e. If you felt that a salesperson was rude to you feel free to let others know. However making a comment like the salesperson was fat, dumb or ugly is NOT acceptable).
4) MovingFraud.com Inc. does not have the ability to review every complaint response so it is your responsibility to ensure that you follow rules 1 to 3. Notwithstanding this fact, MovingFraud.com Inc. does reserve the right to refuse or remove complaint response page that, in its sole discretion, it finds to contravene one of the above mentioned rules.