Universal Complaints Department

Complaint Form

Galactic Region:
Reference Number:
Date:

Complainant -
First Name:
Last Name:

Gender:
Title/s:
Ms.
Mrs.
Miss.
Mr.
Dr.
Prof.
Master.
Mistress.
Mademoiselle.
Madame.
Monsieur.
Sir.
Dame.
Lord.
Lady.
Knight.
Viscount.
Viscountess.
Marquis.
King.
Queen.
Prince.
Princess.
Minister.
President.
Prime Minister.
Galactic Overlord.
CEO.
God.
Goddess.
Muse.
Other (Please specify).

Status:
Living:
Dead:
Undead:
Angel:
Demon:
Non-Corporeal Entity:
Deified:
Other (Please specify):


Subject of Complaint:
Complaint:

Please note that there may be a waiting period in processing your complaint. Adjustments to form processing times may occur. We strive to achieve maximal efficiency at all times, subject to the phases of the moon, and Mildred's rather limited supply of patience.

Office Use Only -
Signature:
Approved:
Wait-listed:
Ref. Code: