Form Ib-001 - Consumer Complaint Template
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3OFFICE OF THE ATTORNEY GENERAL ERIC T. SCHNEIDERMAN
STATE OF NEW YORK DEPARTMENT OF LAW
Bureau of Internet & Technology
Consumer Hotline
rd
120 Broadway, 3
Floor
(800) 771-7755
New York, NY 10271
TDD (800) 788-9898
Phone: (212) 416-8433 Fax (212) 416-8369
1. Please be sure to complain to the company or individual before filing a complaint.
2. Please type or print clearly in dark ink. Form may also be filled in online using Adobe Acrobat version 5.0
(or later) and printed out for mailing.
3. Complete the entire form. Incomplete or unclear forms will be returned to you.
4. Please attach photocopies—no originals—of supporting documents.
CONSUMER
Name
Home phone
Business phone
Street Address
Email address
City/Town
County
State
Zip
COMPLAINT:
Name of seller or provider of services
Phone
Email address
Street Address
Website
City/Town
County
State
Zip
Date of transaction
Cost of product or service
Method of payment
Did you sign a contract?
Yes
No
Date signed:
Where signed:
IB001 - (rev. 8/12)
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Parent category: Legal