Consumer Complaint Form (Page 2 of 2) in pdf

Fill out a complaint if about a motor vehicle or appliance

Make: _________________________________________Model: __________________________Year: _______________________

Mileage: _______________________________________Purchased:

New

Used

Sold:

With Warranty

As Is

Briefly describe your complaint:__________________________________________________________________________________

__________________________________________________________________________________________________________

What form of relief are you seeking (e.g. exchange, repair, refund, etc.)? _________________________________________________

Who referred you to this office? _________________________________________________________________________________

READ THE FOLLOWING BEFORE SIGNING BELOW.

PLEASE ATTACH TO THIS FORM PHOTOCOPIES of any papers involved (contracts, warranties, bills received, canceled

checks - front and back, correspondence, etc.) DO NOT SEND ORIGINALS.

In order to resolve your complaint we may send a copy of this form to the person or firm you are complaining about.

In filing this complaint, I understand that the Attorney General is not my private attorney, but represents the public in enforcing laws

designed to protect the public from misleading or unlawful business practices. I also understand that if I have any questions concerning

my legal rights or responsibilities, I should contact a private attorney. I have no objections to the contents of this complaint being

forwarded to the business or person the complaint is directed against. The above complaint is true and accurate to the best of my

knowledge.

Signature:_______________________________________________________________Date: ______________________________

Have you enclosed copies of important papers?

Return to:

Attorney General Jim Ryan

Consumer Protection Division

500 South Second Street

Springfield, IL 62706

217/782-1090 or 800/243-0618

Consumer Complaint Form Page 2