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Unwanted Calls Form

Fill out this easy survey to hold our politicians accountable.  Let us know who is calling you!

* First Name Middle * Last
Organization
Title
Address
City State
Zip
Country
* Please provide at least one way of contacting you.
Home Phone Office Mobile
Fax Pager
* Email
* Confirm Email
Website
IM ID

Who was the candidate?

Democratic Presidential Candidate or Surrogates
Republican Presidential Candidate, or surrogates.
Other candidate.   (Federal, State, or local candidates)

What was the unwanted contact?

Automated Phone Call (robocall)
Home
Work
Cell
Live Phone Call
Home
Work
Cell
Email (spam)
Home
Work
Direct Mail (junk mail)
Home
Work
Fax
Home
Work
In Person Contact
At home
In public

When did this occur? Please select the day and the time of the occurrence.

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
* In which state did this occur?  (NOTE:  If you live in CA or MN, please use our specific state forms)

CA form.
MN form.
If you can remember, what was the originating telephone number (from your caller ID, if you have one)?
* What was the content of the call?  Please be as specific as possible?
* Who paid for the call?  (usually you would hear this at the end of the call, if at all)  For example "Paid for by John McCain for America"
Do you have anything else to add?
Type the letters and numbers you see in the image:

  
  
  
  
  
 

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