Ponderosa Community Club
Complaint Form

21100 Cayuse Street
Leavenworth, WA  98826
(509) 763-0320 Phone/Fax
pccoffice@nwi.net&

     Date:  ____________________________

Submitted By:                                                                                     

Name:  ____________________________________________ 

Address:  __________________________________________

Phone:  _____________________________      Email:  ___________________________

Problem/Description:

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Address of Problem:

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Suggested Action:

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Signature of Submitter