Consumer Complaint Form - Oregon Department Of Justice
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1
2Ellen F. Rosenblum
Frederick M. Boss
Attorney General
Deputy Attorney General
OREGON DEPARTMENT OF JUSTICE
CONSUMER COMPLAINT FORM
P
N
F
:
LEASE
OTE THE
OLLOWING
Under Oregon Law, the Attorney General cannot act as your private attorney or give you legal advice. Deadlines may prevent you from starting
a lawsuit if you wait too long, you may wish to contact a private attorney. Filing this complaint does not change any deadlines.
1. P
. T
2. R
LEASE COMPLETE THIS FORM USING DARK INK
YPE OR
ETURN THIS FORM ALONG WITH COPIES OF ALL SUPPORTING
.
. DO NOT SEND YOUR ORIGINALS!
PRINT CLEARLY
DOCUMENTATION
Information about you – Fields marked by an asterisk * are required.
* First Name:
* Last Name:
* Mailing Address:
* City:
* State:
* Zip:
WY
* Day Phone:
Cell:
Email:
-I would like to receive FRAUD & SCAM ALERTS.
(Email address required)
-I am not requesting action on this complaint.
-I am over 65 years of age.
-I am under 30 years of age.
-English is not my first language.
-I am a Veteran.
-I would like info on Veteran’s Benefits.
D
,
. F
EPENDING ON THE TYPE OF BUSINESS INVOLVED
THERE MAY BE OTHER STATE AGENCIES THAT CAN HELP
OR A COMPLETE LIST OF
,
-
://
.
.
/P
/
_
_
_
.
AGENCIES
PLEASE VISIT
HTTP
WWW
OREGON
GOV
AGES
A
TO
Z
LISTING
ASPX
Please provide information about the business or person in which you are submitting the complaint about.
Name of Business:
Mailing Address:
City:
State:
Zip:
WY
Phone Number:
Business Email Address:
I
,
. C
.
F YOU PAID BY CREDIT CARD
THE CARD ISSUER MAY OFFER RELIEF OR PROTECTION
ONSIDER CONTACTING YOUR CREDIT CARD COMPANY
$$ Money Lost:
Date of Transaction:
2017
01,
JANUARY
Type of Service or Transaction:
-Motor Vehicles
-Home & Mortgage
-Phone, Internet & TV
-Sales, Scams & Fraud
-ID Theft & Data Breaches
-Credit, Loans & Debt
FOR OFFICIAL USE ONLY
If your complaint is about TOWING, provide the License Plate #:
File Number:
State:
Plate #:
WA
Complaint Code:
Business Code:
If your complaint is about a WEBSITE, provide the Website
URL:
Closing Code:
Return to:
Letter Type:
CC:
If you have an ACCOUNT with this business, provide the
Notify:
Account #:
Add’l Notify:
Rec’d From:
W
?
Referred To:
HOM HAVE YOU CONTACTED CONCERNING YOUR COMPLAINT
$$ Lost:
B
N
:
USINESS
AME
-Consumer Complaint -Web Search -Confidential
Notes:
O
:
THER
A
? -Y
-N
RE YOU REPRESENTED
ES
O
A
’
N
:
TTORNEY
S
AME
P
#:
HONE
Coded By: __________ Date: __________ DM# 8406566 | Rev 08/14/17
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Parent category: Legal