PrivacyBot -- Complaint Form

PrivacyBot Complaint Form

Use this form to file a privacy complaint against a site displaying the PrivacyBot Trustmark. Your grievance will be structured into a Notice of Mediation and Complaint. We will send these papers to you and to the site's official contact.

PrivacyBot orchestrates an online mediation according to our Mediation Rules. We help get your Complaint elevated attention and provide program incentives to help resolve it within fixed deadlines. Unfavorable outcomes are noted on the site's Registry Statement.

There is a $1.50 filing fee (visa/mc). This discourages complaints by minors and frivolous or multiple complaints. Filing fees are donated to unrelated nonprofit privacy groups. Note: PrivacyBot mediation is voluntary and does not preclude you from filing a complaint with the FTC.

Information About the Web Site:

Site:
Name of web site you have a grievance against

URL:
Exact URL of the web site you have a grievance against

This Site's PrivacyBot Registry Number:
(Click on the PrivacyBot Trustmark appearing on the Site to see its Registry Number)

Information About You:

First-time Users:

Your Full Name:
Your Email Address:
Your Email (again):
Choose a Password:	(at least 5 characters)
Type it Again:	(please write this down. You'll need it to access "Account Manager")

Returning Users Only:

Your Email Address:
Your Password:

Information About Your Grievance:

Summary:

Explain Why You Are Filing a Complaint: (required)
Please avoid emotional language and flaming. Stick to the facts: What happened? When did it happen? Why are you bothered? How does it harm you? (use numbered paragraphs to help organize your thoughts)

I am filing this Complaint for the following reasons: 1. 2. 3.
(Be concise. Do not include personal data, such as bank account or credit card numbers)

How Can the Web Site Resolve this Matter? (required)
Tell them what you want. Do you want the site to change its behavior? To stop using your personal data for marketing purposes? To stop sharing your data with third parties? To correct or remove personal data collected from you? To change its Privacy Policy in some way?

To resolve this Complaint, I would like the web site to...
(Be concise. Do not include personal data, such as bank account or credit card numbers)

PAYMENT INFORMATION (required):

Nonrefundable Filing Fee: $1.50 (Visa/Mastercard)

Billed by Invisible Hand Software, LLC of Annandale, Va., Site Operator
Your statement will show: INVISIBLE HAND SFTWR LLC ANNANDALE VA

Name on Credit Card:
Credit Card Number:
Card Expiration Date:

Click below to file this Complaint subject to our Mediation Rules.

(Note: nothing will happen if you have not supplied all information)

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