Victims Comp Portal Feedback Tell us about yourself and your request Question Title * 1. What is your name? Question Title * 2. What is your email address? Question Title * 3. What is your best contact phone? Question Title * 4. If you currently receive payments from Victims Compensation Division, or anticipate doing so in the future, then please provide the primary financial contact for your organization (E-mail/phone)? Name Email Phone Question Title * 5. Are you providing general feedback, experiencing an issue, reporting a defect/bug Provide general feedback or Have a question Experience an issue or Report a defect/bug Request change to Organization Locations or Remit To Request to add a Service Provider for as a Referral Agency Next
