State Seal

Terry Goddard
Arizona Attorney General

Consumer Complaint Form
Click Here for the Consumer Complaint Form Instructions (en español)
Items marked in Red and with an * are required. (Either the address or e-mail address of business required.) Press tab to go from field to field.
  YOUR INFORMATION   PARTY OR FIRM YOU ARE
COMPLAINING AGAINST
First Name: *Name:
Last Name: *Address:
Address: City:
City: State:
State: Zip:
Zip: Phone:
(if known)
Home Phone:
Additional Phone:
Work Phone:
*e-mail address:
Facsimile:
website address:
e-mail address:    

May we send a copy of this to the person or firm you are complaining against?
Yes No
(If your response is no, we may be prevented from taking any action on your complaint.)

Please explain the entire circumstances surrounding your complaint below.
Please fully describe any oral or written misrepresentations made to you:

Have you complained to the firm?
Yes No

What was their response?

Was an oral or written warranty given?
Yes No

Did you sign any documents?
Yes No

Date of Transaction:

Place of Transaction:

(examples: home, store, Internet)

Total amount of damages (list actual loss only):

Salesperson's Name :

Witness to Transaction:

Was the product or service advertised?
Yes No

If yes, indicate the date and how it was advertised:

Do you have an attorney?
Yes No

If yes, please provide the attorney's name and address:

Is any legal action pending?
Yes No

List any other consumer agencies contacted:

May we provide your name and telephone number to the media in the event of an inquiry about this matter?
Yes No

May we send a copy of your complaint to another government agency for their review or investigation?
Yes No

Statistical Information

For statistical purposes, please indicate if you are:

Under the age of 60 Age 60 and over.

Currently in Military Service Veteran N/A

How did you hear about our complaint form:

Called Phoenix AG Office
Called Tucson AG Office
Went onto AG Website
Visited an AG Satellite Office
An Out of State Agency
Media: Newspaper/Radio/TV
Another Arizona State Agency/State Legislator
Attended AG Presentation/Event
Other

Comments:

Declaration: By submitting this form electronically, I declare, under penalty of perjury under the laws of the state of Arizona that the information in this complaint is true and accurate to the best of my knowledge.

Name:

Date:

Thank you for taking the time to complete this form.

Please print the following page for your records!