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Complaint Form 
1. Before you submit the complaint form, please make sure you reach out to the utility you have the dispute with 
to allow them to rectify the problem. 
2. Submit a copy of all letters, receipts, or any other documentation that may support your claim. Please note that 
as a part of the complaint handling process, the Public Services Commission (PSC) may forward a copy of this 
complaint to the utility complained against. 
 
____ St. Croix 
____ St. Thomas 
____ St. John 
 
Customer Information 
Customer Name (as 
indicated on account): 
Date:
Name of Authorized Complainant if different 
than above: 
 
Physical Address: 
Location of the complaint 
Apartment/Unit # 
 
City 
State 
ZIP Code 
 
Phone: 
Email
 
Is this service for your 
home or business: 
Name of 
Utility:
Account Number:
 
Mailing 
Address: 
Complaint Received Via: 
(In person, Phone, Email)  
 
Briefly describe your complaint. Indicate specific details, i.e., dates, names, and occurrences. 
 
 
 
 
 
 
 
By submitting this complaint, you are stating that the information contained in the complaint and any 
attachments or exhibits is true and accurate to the best of your knowledge. 
GOVERNMENT OF THE UNITED STATES 
VIRGIN ISLANDS 
FOR OFFICIAL USE ONLY 
 
PSC COMPLAINT NO.: __________________________ 
 
RECEIVED BY: ________________________________ 
 
DATE RECEIVED: ______________________________ 
 
REFERRED TO: ______________ DATE: ___________