"Consumer Complaint Form" - Ohio

Consumer Complaint Form is a legal document that was released by the Ohio Attorney General - a government authority operating within Ohio.

Form Details:

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  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Ohio Attorney General.

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Consumer Protection
Office 800-282-0515
Fax 866-268-2279
30 E. Broad Street, 14
Floor
th
Columbus, Ohio 43215
www.OhioAttorneyGeneral.gov
Office Use Only:
Consumer Complaint Form
Complaint #:
The Ohio Attorney General’s Consumer Protection Section provides a complaint resolution process to resolve disputes
between consumers and businesses. If you have a complaint regarding a consumer transaction (a purchase or
advertisement of a product or service used for the home or personal use), you may file a complaint with our office.
You May File a Complaint One of Three Ways:
By phone:
By mail:
Online:
Complete this form in dark ink and mail to:
Call 8 8 00-282-0515
Visit w w ww.OhioAttorneyGeneral.gov
Consumer Protection Section
On our Web site, you can file a
Our help center associates
30 E. Broad St., 14th floor
complaint, sign up for our e-newsletter
will assist you in filing your
Columbus, OH 43215-3400
and learn about your consumer rights.
complaint.
Pre-Complaint Questions:
Have you contacted the company about your complaint?
Yes
No
Have you hired an attorney to represent you in this matter?
Yes
No
If yes, provide: Attorney’s name :
Attorney’s phone number : (
)
Are you involved in a lawsuit regarding this issue?
Yes
No
Have you contacted any other agencies regarding this issue?
Yes
No
If yes, please list the agencies :
PLEASE NOTE: Any information you submit with your complaint is considered public and may be released as
part of a public records request. Remove Social Security numbers, credit card numbers, debit card numbers
and other bank account numbers from any documents you submit with your complaint.
Information about You (the Consumer):
First name:
MI:
Last name:
Suffix :
Address :
City :
State :
Zip Code :
County :
Country :
Daytime phone : (
Alternate phone : (
)
)
E-mail address :
Fax : (
)
Subject of the Complaint (Business Information):
Name of business you’re complaining about :
Address :
City :
State :
Zip Code :
County :
Country :
Telephone : (
Toll-free : (
Fax : (
)
)
)
E-mail address :
Web address :
Name of business owner/salesperson :
Consumer Protection
Office 800-282-0515
Fax 866-268-2279
30 E. Broad Street, 14
Floor
th
Columbus, Ohio 43215
www.OhioAttorneyGeneral.gov
Office Use Only:
Consumer Complaint Form
Complaint #:
The Ohio Attorney General’s Consumer Protection Section provides a complaint resolution process to resolve disputes
between consumers and businesses. If you have a complaint regarding a consumer transaction (a purchase or
advertisement of a product or service used for the home or personal use), you may file a complaint with our office.
You May File a Complaint One of Three Ways:
By phone:
By mail:
Online:
Complete this form in dark ink and mail to:
Call 8 8 00-282-0515
Visit w w ww.OhioAttorneyGeneral.gov
Consumer Protection Section
On our Web site, you can file a
Our help center associates
30 E. Broad St., 14th floor
complaint, sign up for our e-newsletter
will assist you in filing your
Columbus, OH 43215-3400
and learn about your consumer rights.
complaint.
Pre-Complaint Questions:
Have you contacted the company about your complaint?
Yes
No
Have you hired an attorney to represent you in this matter?
Yes
No
If yes, provide: Attorney’s name :
Attorney’s phone number : (
)
Are you involved in a lawsuit regarding this issue?
Yes
No
Have you contacted any other agencies regarding this issue?
Yes
No
If yes, please list the agencies :
PLEASE NOTE: Any information you submit with your complaint is considered public and may be released as
part of a public records request. Remove Social Security numbers, credit card numbers, debit card numbers
and other bank account numbers from any documents you submit with your complaint.
Information about You (the Consumer):
First name:
MI:
Last name:
Suffix :
Address :
City :
State :
Zip Code :
County :
Country :
Daytime phone : (
Alternate phone : (
)
)
E-mail address :
Fax : (
)
Subject of the Complaint (Business Information):
Name of business you’re complaining about :
Address :
City :
State :
Zip Code :
County :
Country :
Telephone : (
Toll-free : (
Fax : (
)
)
)
E-mail address :
Web address :
Name of business owner/salesperson :
About the Transaction:
How did the first contact with the company occur?
Product/service involved :
Date of purchase :
(mm/dd/yyyy)
E-mail
Mail
/
/
Did you sign a contract?
Yes
No
Fax
Radio
Are you making payments?
Yes
No
Home visit
Store visit
Total cost of product/service : $
Infomercial
Telephone call
Method of payment :
Internet auction
Television
Internet banner/Web site
Word of mouth
Amount paid so far : $
Disputed amount : $
Magazine/Newspaper
Is the product/service under warranty?
Yes
No
Other :
If yes, warranty company name :
Describe the transaction and your complaint :
Briefly describe what you would consider a reasonable resolution to your complaint :
ONLY
Motor Vehicle Complaints
:
Complete this section only if your complaint regards a motor vehicle :
Make :
Model :
Purchase / Lease (circle one)
Vehicle Identification Number (VIN—not your license plate number) :
Year of vehicle :
New / Used (circle one)
Under warranty / “AS IS” (circle one)
Mileage at purchase or lease :
Current mileage :
Acknowledgment of Terms and Conditions:
By checking this box I acknowledge that the information given above is true to the best of my knowledge and belief. I
understand that any information I submit to the Ohio Attorney General’s Office is considered public information and may
be released in a public records request. I understand a copy of this form and all documents relating to my complaint will
be forwarded to the company that is the subject of my complaint. I understand that the Ohio Attorney General cannot
serve as my private attorney.
D
Date submitted :
(mm/dd/yyyy)
/
/
Consumer Protection
Office 800-282-0515
Fax 866-268-2279
30 E. Broad Street, 14
Floor
th
Columbus, Ohio 43215
www.OhioAttorneyGeneral.gov
Office Use Only:
Consumer Complaint Form, Part 2
Complaint #:
When you file a consumer complaint with the Ohio Attorney General’s Office, you also must submit copies of documents
related to your complaint, such as contracts and receipts. Submitting these documents helps ensure that you will get the
best possible results from our complaint resolution process. Failure to provide required documentation may prevent or
delay our ability to help you.
Please send this form and copies of any documents related to your complaint to the Attorney General’s Office:
Consumer Protection Section, 30 E. Broad St., 14th floor, Columbus, OH 43215-3400
DO NOT SEND ORIGINALS. Any documents sent to our office will be scanned electronically and then destroyed.
PLEASE NOTE: Any information you submit with your complaint is considered public and may be released as
part of a public records request. Remove Social Security numbers, credit card numbers, debit card numbers
and other bank account numbers from any documents you submit with your complaint.
Documents to Submit with Your Complaint:
Check below to indicate which documents/items you are submitting with your complaint (check all that apply):
HUD 1 Settlement Statement (Residential Mortgage
Contract / Purchase Agreement
Transactions Only)
Warranty / Service Agreement
Debt Collection Account Number* (Debt Collection
Invoice / Billing Statement
Complaints Only):
Payment Record / Receipt
Advertisement
Other:
Estimate / Proposal
Loan Application
*DO NOT SUBMIT YOUR BANK ACCOUNT NUMBER OR
SOCIAL SECURITY NUMBER.
Additional Information about You:
To help our office better serve Ohio consumers, please check any/all categories that apply to you (optional):
Active service member or immediate family of active service member
Disaster victim
Non-English speaking
Person with disability
Over the age of 65
Veteran
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