Step 2 - Your Information

Please complete form carefully.

Name (First M. Last)
Address (123 Main St, Apt #)
City
State	Select from this List Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming ------
Zip
Phone (321-456-7890)
State of Incarceration	Select from this List Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming ------

On the list below, please check the problems you have
encountered with the prison telephone system.
Use the “other” option below to briefly describe problems not listed.

	I have been charged for calls I was not home to receive.
	I have had calls prematurely terminated.
	I have had my phone number blocked, apparently because the phone company with whom the prison system has contracted does not have a billing agreement with my local phone company.
	I am charged exorbitant rates, in part because the phone company that operates the inmate phone service offers (and the state agrees to accept) an unreasonably high commission.
	I am not allowed less expensive calling options.  There is no technical reason why I should not be able to receive prepaid debit calls that avoid operator assistance and can be billed profitably at considerably lower rates.
	I am forced to pay in advance for collect phone calls, and never receive an accounting of dates, times, and length of calls charged against that prepayment.

Other complaint(s) not listed:



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