Resale Scam Incident Report – Phone Call

First Name 

Last Name 

E-mail Address 

Phone Number 

Did you give permission for the business to contact you? 

Yes 

No 

What type of contact was made with you? (i.e. recorded voice, live call) 

Are you the bill payer/subscriber for the telephone that received the call? 

Telephone number the call was from: 

The name of the organization (if known): 

Telephone number the call was received on: 

Date and time of the call: 

Is the number the call was received on registered with a service provider: 

What was the call about/what was the content: 

What further information do you have about the instigator of the call: 

Do you require any further assistance in relation to concerns about the company that contacted you? *

Yes 

No 

If yes to above, please let us know how we can help?