Consumer Complaint Form (Page 2 of 2) in pdf

EXPLAIN YOUR COMPLAINT IN DETAIL (use additional pages if necessary):

____________________________________________________________________________________________

What do you think the business should do to resolve your complaint? (Circle One)

Refund

Deliver Product

Perform Service

Other

Explain if you have circled “Other”:

__________________________________________________________________________________________________________________________________________

Bellingham: Island, San Juan, Skagit and Whatcom

Seattle: North King, Snohomish, Clallam and

Tacoma: Pierce, Mason, Grays Harbor, Kitsap, and

Jefferson Counties and Bainbridge Island

South King County

103 E. HOLLY, SUITE 308

800 FIFTH AVENUE, SUITE 2000

PO Box 2317

BELLINGHAM, WA 98225-4728

SEATTLE, WA 98104-3188

TACOMA WA 98401-2317

(360) 738-6185

fax (360) 738-6190

(206) 464-6684

fax (206) 389-2801

(253) 593-2904

fax (253) 593-2449

Spokane: Eastern Washington

This form should be returned to the address nearest to

Vancouver: Clark, Cowlitz ,Pacific, Skamania,

you. After your complaint is received, you will be

Wahkiakum, Lewis, and Thurston Counties

1116 WEST RIVERSIDE

contacted regarding assignment of your complaint.

1220 MAIN STREET, SUITE 549

SPOKANE WA 99201-1194

Please include copies of related documents.

VANCOUVER WA 98660-2964

(509) 456-3123

fax (509) 458-3548

SEND COPIES ONLY - DO NOT INCLUDE

(360) 759-2150

fax (360) 759-2159

ORIGINAL DOCUMENTS

E-MAIL NOTIFICATION

The Attorney General's Office will periodically issue press releases, consumer warnings and other notifications to the public. We would like to

Yes

include you in our e-mail list for these notifications. Please check "Yes" if you want to receive these notifications.

SIGNATURE

I declare, under penalty of perjury under the laws of the State of Washington, that the information contained in this complaint is true and

accurate, and that any documents attached are true and accurate copies of the originals.

I understand that my complaint and the related documents will become a “public record” and under state law can be subject to a public records

disclosure request and thus be seen by other people.

Signature

Date

City and State where signed

Consumer Complaint Form Page 2

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