Customer Contact Form

Please complete this form if you have a complaint, concern or a compliment.


If you prefer to download our Customer Contact Form and mail it to us, select your language. Mailing instructions are on the form.
ENGLISH FRENCH SOMALI ARABIC

SECTION 1: Contact Information

Name(*)
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Street
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City
Please enter a valid city

Zip
Please enter a valid zipcode

Phone
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Email(*)
Please provide a valid email

Accessible Format Requirements:
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SECTION 2: Type of Complaint/Comment

Type of Complaint (select all that apply)

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Are you filing this on your own behalf?
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If yes, go to Section 3. If no, please supply the name and relationship of the person for whom you are submitting this claim.
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Please explain why you have filed for a third party
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Please confirm that you have obtained the permission of the aggrieved party if you are filing on the behalf of a third party:
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SECTION 3: Details of Complaint or Incident

Date of Incident(*)

Please select a day the incident occurred

Time of incident. Include AM or PM
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1. General Complaint, Concern or Incident

Bus Number
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Route Number
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Please Explain
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2. Civil Rights / Title VI Complaint:

Discrimination based on (check all that apply)
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Please explain below. Be as specific as possible.
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Explain below as clearly as possible what happened and why you believe you were discriminated against. Describe all persons involved. Include name and contact information of person(s) who discriminated against you (if known) as well as names and contact information of witnesses.

Please explain below:
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3. ADA Discrimination: Discrimination based on a disability. • Describe all persons who were involved. include the names and contact information of the person(s) who discriminated against you (if known) as well as the names and contact information of any witnesses. • If this complaint is related to equipment or structures (for example: buses or bus stops), please try to be as specific as possible in identifying which vehicle or locations may be creating the situation. • Explain below as clearly as possible what happened and why you believe you were or are being discriminated against based on your disability.

Please explain below:
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SECTION 4:

Have you previously filed a complaint with this agency? If no go to Section 5.
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If so, what type of complaint did you file?
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What other type of complaint did you file?
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SECTION 5:

Ever filed this complaint with any other Federal, State or local agency, or any Federal or state court? If no go to Section 6.
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Federal Agency Name
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State Agency Name
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Local Agency Name
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Federal Court Name
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State Court Name
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Please provide information about a contact person at the agency/court where the complaint was filed.

Name
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Title
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Agency
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Phone
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Email
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Address
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SECTION 6: Additional Comments

Contact information is required for a response.

Name (*)
Please enter your first and last name

Email or phone(*)
Please enter a valid email or phone number.

Additional Comments
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Buy submitting this form you are stating that the information you provided is true and accurate to the best of your knowledge. You are also giving METRO and it's agents the right to verify any and all information. Thank You

Thursday the 27th. 114 Valley Street Portland, ME 04102 (207) 774-0351
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