Consumer Information
Title:
*
First Name:
*
Last Name:
*
Address:
*
City:
*
State:
*
Zip Code:
*
Email Address:
*
(Do not add space or punctuation after email address)
Phone:
*
Date of purchase or contract:
Age:
*
Please check appropriate box if you or your spouse are an active or former duty service member or U.S. military veteran:
Who are you complaining about?
My Complaint is Against (Company or Name of Individual):
Company or Individual's Address:
Company or Individual's City:
Company or Individual's State:
Authorized Submission Number: *
Company or Individual's Zip Code:
Company or Individual's Phone Number:
Email Address (if available):
Company or Individual's Fax Number:
Product or service involved:
Brand name of product (for example, Lysol, Huggies, Duracell):
Size of Product (for example, 14 oz., 40 count, 12 rolls, Four 4-pack, 1 gallon, etc.):
Additional product/item descriptions (for example, extra-duty, caffeine-free, two-ply, jumbo, 20% more, ultra, skim, 80 lb. ready-to-use concrete mix, 2 x 4 x 8 plywood):
Amount of purchase or contract:
Actual amount paid:
How did you pay?:
Have you contacted the business or person?:
Have you contacted an attorney?:
What do you think should be done to resolve your complaint fairly?:
Summary of your complaint. Please attach product images, including advertised price, and receipts:
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Note: For uploading more than three attachments in the same submission, please use file compression or "zip" software. For information about using zip software, click here .
If mailing attachments:
Note: Complaints are "Open Records."
I understand that the Attorney General's Office is not my private attorney but represents the public in enforcing laws designed to protect consumers from misleading or unlawful business practices. I also understand I may contact a private attorney for legal advice.
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