Consumer Complaint Form printable pdf download

Consumer Complaint Form

Date: _____________________________________

Name: _______________________________________________________________________________________________

Address: _____________________________________________________________________________________________

City: _________________________________________________________

Postal Code: _________________________________________________

Phone Number: (Work) __________________________________

(Home) _________________________________

(Cell) _________________________ Email address (if available): __________________________________

Complaint category (please check one):

Cemetery Services

Pre-Need Cemetery Services

Charitable Solicitations

Residential Tenancies

Mobile Home Site Tenancies

Loan Brokers

Negative Options

Credit Reporting

Timeshares

Direct Selling

Home Renovations

Retail Home Sales

Employment Agencies

Natural Gas Marketing

Auctions

Collection Practices

Credit Contracts

Unfair Trade Practices

Bond Claims

Electricity Marketing

Other: _________________________________________________________________________________

Name of business: ___________________________________________________________________________________

Address (if known): __________________________________________________________________________________

City: ___________________________________________________

Telephone Number (if known): _________________________

Contact persons for the company: ____________________________________________________________________

Please provide a brief factual description of the problem you experienced. To help us review your

complaint, please be sure to include details such as date, location, name of persons you dealt with,

witnesses if any and what documents you have available.

______________________________________________________________________________________________________

Page 1

Consumer Complaint Form