Consumer Fraud Complaint Form

Form

Your Information

Name

Address

Street Address Address Line 2 City State ZIP Code

Phone Number:

Email

About the business

Who is your complaint against?

Owner / Operator:

Did you complain to the business?

Yes

No

Date of complaint:

Name and Title of the person you spoke to:

Date of contract / transaction sale

Location of contract / transaction sale

How much money did you pay?

What payment method did you use?

Cash

Personal Check

Credit Card

Money Transfer Service (Venmo, Cash App, Zelle, etc.)

Other

Please describe the events in the order that they happened, and tell us what you would like done about this incident.

Name of Attorney / Other agencies you have contacted

Have you filed in Small Claims Court?

Yes

No

If yes, have the parties been served?

Yes

No

Court Date:

Please note that, if required by law, your complaint may be sent to the Person or Company you want investigated. If not required by law, do you still want a copy of this complaint to be sent to the Person or Company complained about?

Yes

No

Form