USGSA or AMA Complaint Form

Relationship to FGIS
If the violation involves a representative from an Official Service Provider (OSP) or Field Office please select the list below.
Provide details concerning the violation(s). So far as practicable, the information shall include such of the following items as may be applicable:
  • The name and address of each person and of the agent, if any, representing such person in the transaction involved;
  • Place where the alleged violation occurred;
  • Quantity and quality or grade of each kind of product or article involved;
  • Date of alleged violation;
  • Car initial and number, if carlot;
  • Shipping and destination points;
  • If a sale, the date, sale price, and amount actually received;
  • If a consignment, the date, reported proceeds, gross, net;
  • Amount of damage claimed, if any;
  • statement of other material facts, including terms of contract; and
  • So far as practicable, true copies of all available papers relating to the transaction complained about, including shipping documents, letters, telegrams, invoices, manifests, inspection certificates, accounts of sales and any special contracts or agreements.
I certify that the information provided is true and correct to the best of my knowledge and belief.*  
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