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Consumer Assistance Program Complaint Form

Complaints must include:

    •  Your name and contact information (mailing address, phone number)
    •  The business name and contact information, if you have it (mailing address, e-mail, website, phone number(s))
    •  An outline or details of the complaint
    •  Dollar amount of monetary loss
    •  Your desired outcome or requested resolution
    • Include documentation relevant to your complaint. Organize all the documents in chronological order, with the earliest first and the most recent last.

If you include an email address, you will receive an electronic copy of your complaint. If you do not receive the email, check your junk email folder.

Complaints are public record, and all documents you send us will be saved electronically.

Your complaint will be forwarded to the business for response. Your complaint is not anonymous.

Do not send materials containing Social Security numbers, account numbers, or other sensitive information with your complaint unless you remove or mark over the information.

If the business does not respond favorably to your complaint, we may refer you to a private attorney or small claims court.

Contact the Consumer Assistance Program at (800) 649-2424 with questions.

Your Contact Information

Personal Information

I am a... (Select all that apply)

Complaint Information

When did this incident occur? (If unknown, enter today's date)
One file only.
500 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.