Form CPFR-2 "Consumer Statement - Food or Bottled Water" - Connecticut

What Is Form CPFR-2?

This is a legal form that was released by the Connecticut State Department of Consumer Protection - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2017;
  • The latest edition provided by the Connecticut State Department of Consumer Protection;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CPFR-2 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Consumer Protection.

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Download Form CPFR-2 "Consumer Statement - Food or Bottled Water" - Connecticut

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CPFR-2 Rev 8/17
For Official Use Only
CONSUMER STATEMENT
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
450 Columbus Blvd. Ste 901
Hartford, CT 06103
E-Mail: dcp.foodandstandards@ct.gov
Fax No. (860) 706-1209
1. Complete this form. Type or print CLEARLY.
2. Return form to Agency at address shown above.
HOME PHONE (Include Area Code)
BUSINESS PHONE (Include Area Code)
ARE YOU 65 OR OLDER?
YOUR NAME
YES
NO
STREET ADDRESS
CITY
STATE
ZIP CODE
E-MAIL
PARTY/COMPANY COMPLAINED AGAINST
PERSON DEALT WITH / TELEPHONE NUMBER (Include Area Code)
POSITION
STREET ADDRESS
CITY
STATE
ZIP CODE
E-MAIL
INFORMATION: WAS A CONTRACT INVOLVED
IF “YES”, ENTER DATE
TYPE OF CONTRACT:
PRODUCT OR SERVICE INVOLVED
YES
NO
ORAL
WRITTEN
DATE PURCHASED
COST
HOW PAID
$
CASH
CREDIT CARD
INSTALLMENT CONTRACT
LAW-AWAY
WAS THE PRODUCT OR SERVICE ADVERTISED
HOW?
DATE & PLACE OF AD (PLEASE ATTACH COPY IF POSSIBLE)
YES
NO
HAVE YOU CONTACTED THE COMPANY REGARDING
IF “YES” ENTER DATE
PERSON CONTACTED
POSITION
YOUR COMPLAINT?
YES
NO
HAVE YOU HIRED AN ATTORNEY
IF “YES”, NAME
IS COURT ACTION PENDING?
IF “YES”, IN WHAT COURT?
YES
NO
YES
NO
NOTE: Please provide a short, detailed statement regarding the facts of your complaint below. Also, please attach copies of all relevant
documentation. If further documentation is needed you will be notified. We will not be able to return or forward any material sent to this department
so please keep copies of everything you send to us for your records.
We encourage consumers to try and resolve their issues with the company involved. More information can be obtained from our website:
www.ct.gov/dcp. You may also find information on the Small Claims Court and Superior Court process at
www.jud.state.ct.us
.
SIGNATURE
DATE
Attach as many additional pages as needed to complete your statement.
Note: All complaints are public information. By submitting this complaint, you give the Department of Consumer Protection your
permission to release a copy of this Consumer Statement.
CPFR-2 Rev 8/17
For Official Use Only
CONSUMER STATEMENT
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
450 Columbus Blvd. Ste 901
Hartford, CT 06103
E-Mail: dcp.foodandstandards@ct.gov
Fax No. (860) 706-1209
1. Complete this form. Type or print CLEARLY.
2. Return form to Agency at address shown above.
HOME PHONE (Include Area Code)
BUSINESS PHONE (Include Area Code)
ARE YOU 65 OR OLDER?
YOUR NAME
YES
NO
STREET ADDRESS
CITY
STATE
ZIP CODE
E-MAIL
PARTY/COMPANY COMPLAINED AGAINST
PERSON DEALT WITH / TELEPHONE NUMBER (Include Area Code)
POSITION
STREET ADDRESS
CITY
STATE
ZIP CODE
E-MAIL
INFORMATION: WAS A CONTRACT INVOLVED
IF “YES”, ENTER DATE
TYPE OF CONTRACT:
PRODUCT OR SERVICE INVOLVED
YES
NO
ORAL
WRITTEN
DATE PURCHASED
COST
HOW PAID
$
CASH
CREDIT CARD
INSTALLMENT CONTRACT
LAW-AWAY
WAS THE PRODUCT OR SERVICE ADVERTISED
HOW?
DATE & PLACE OF AD (PLEASE ATTACH COPY IF POSSIBLE)
YES
NO
HAVE YOU CONTACTED THE COMPANY REGARDING
IF “YES” ENTER DATE
PERSON CONTACTED
POSITION
YOUR COMPLAINT?
YES
NO
HAVE YOU HIRED AN ATTORNEY
IF “YES”, NAME
IS COURT ACTION PENDING?
IF “YES”, IN WHAT COURT?
YES
NO
YES
NO
NOTE: Please provide a short, detailed statement regarding the facts of your complaint below. Also, please attach copies of all relevant
documentation. If further documentation is needed you will be notified. We will not be able to return or forward any material sent to this department
so please keep copies of everything you send to us for your records.
We encourage consumers to try and resolve their issues with the company involved. More information can be obtained from our website:
www.ct.gov/dcp. You may also find information on the Small Claims Court and Superior Court process at
www.jud.state.ct.us
.
SIGNATURE
DATE
Attach as many additional pages as needed to complete your statement.
Note: All complaints are public information. By submitting this complaint, you give the Department of Consumer Protection your
permission to release a copy of this Consumer Statement.