Ohio > Statewide > Attorney General Office > Citizen Protection
Consumer Complaint Form - Ohio
| Consumer Complaint Form Form. This is a Ohio form and can be used in Citizen Protection Attorney General Office Statewide . |
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Office Use Only Complaint #: CONSUMER COMPLAINT FORM The Ohio Attorney General's Consumer Protection Section provides informal mediation 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. Complete this form in dark ink and mail to: You also may file a complaint: Online, www.ag4ohio.gov, or By phone, 1877AG4OHIO (18772446446) (TTY 18885676881) Consumer Protection Section 30 E. Broad St., 14th floor Columbus, OH 432153400 PRECOMPLAINT QUESTIONS · Have you contacted the company about your complaint? Yes No · Have you hired an attorney? Yes No If yes, please provide the following information: Attorney's name: Attorney's phone number: ( ) · Are you involved in a lawsuit regarding this issue? Yes No PLEASE NOTE: Any information you submit with your complaint is considered public information and may be released as part of a public records request. Please remove Social Security numbers and bank account numbers from any documents you submit with your complaint. INFORMATION ABOUT YOU (THE CONSUMER) Last name: First name: MI: Address: City: State: Zip Code: County: Daytime phone: ( ) Alternate phone: ( ) Email address: Fax: ( ) I would like to receive educational enewsletters and alerts from the Consumer Protection Section. To help our office better serve Ohio consumers, please check any/all categories that apply to you (optional): Active service member or immediate Personal income below $26,000 (or family Over the age of 60 family of active service member Disaster victim income less than 250% of federal poverty level) NonEnglish speaking Person with disability COMPANY/SUBJECT OF THE COMPLAINT Name of company (supplier): Address: City: State: Zip Code: County: Telephone: ( ) Tollfree: ( ) Fax: ( ) Email address: Web address: Name of business owner/salesperson: American LegalNet, Inc. www.FormsWorkflow.com ABOUT THE TRANSACTION Product/service involved: Date of purchase: / / (mm/dd/yyyy) Did you sign a contract? Yes No Are you making payments? Yes No Method of payment: Total cost of product/service: $ Amount paid so far: $ Disputed amount: $ Is the product/service under warranty? Yes No If yes, warranty company name : How did the first contact with the company occur? Email Fax Home visit Infomercial Internet auction Internet banner/Web site Magazine/Newspaper Mail Radio Store visit Telephone call Television Other: MOTOR VEHICLE COMPLAINTS ONLY: 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: Describe the transaction and your complaint. Attach additional sheets if necessary. Attach legible copies of all contracts, letters, receipts, lawsuit documents, advertisements or any other documents related to your complaint (remove Social Security numbers and bank account numbers). DO NOT SEND ORIGINALS. Briefly describe what you would consider a reasonable resolution to your complaint: Have you contacted any other agencies? Yes No If yes, please list the agencies: READ BEFORE SIGNING: 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. Your Signature: Date: American LegalNet, Inc. www.FormsWorkflow.com
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