Complaint Form

Untitled

First Name *

Last Name *

Address *

City *

State/Province

Zip Code/Postal Code *

Country

Phone *

Ex: (202)555-1212

Email *

I am filing this complaint as a

Consumer
Direct Selling Representative/Distributor

Month of incident

Day of Incident

Year of Incident

Only DSA members are subject to DSAs Code of Ethics complaint process. Please use the select member company link below to identify the company against which youd like to file your complaint. If you are not able to identify the company in question, please feel free to browse our list of members

for the company that matches your information, and then use the below search field to identify the company. If you are not able to find a match and are certain the company is a member of DSA, please contact jaquilina@dsa.org for more information.

Member Company Involved

Name of the company representative/distributor involved *

Name of the person at the member company who you have spoken to about this incident

Describe the details of the incident *

Describe the efforts you have made to resolve this matter

Please provide any additional information that might be helpful in resolving the situation

How would you like to see the matter resolved?

Describe the current status of this complaint

Describe any responses the other parties have made to resolve this matter

If possible, identify the Code violation you believe has occurred