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Consumer Protection Complaint Form


Instructions

It is important that you attempt to resolve your complaint with the company before filing with the Division of Consumer Protection (DCP). Complaints already the subject of a lawsuit or other legal action cannot be handled by the DCP.

Please be sure that your statement is complete and factual, but as brief as possible. The DCP will attempt to help you and the company reach a satisfactory settlement. However, we cannot require the company to make an adjustment.

* Required Fields


Printable Complaint Form

If you wish to submit your complaint form via U.S. mail, please complete, print and sign the Printable Complaint Form and submit it to:

New York State Department of State
Division of Consumer Protection
Consumer Assistance Unit
99 Washington Avenue
Albany, New York 12231-0001

Consumer Assistance Hotline:
(518) 474-8583
(800) 697-1220

Help Prevent Fraud

Report a licensee violation to the Division of Licensing Services
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CONSUMER INFORMATION

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* Yes No

COMPANY INFORMATION

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COMPLAINT INFORMATION

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Please type a clear description of the complaint (e.g., nature or type of complaint: car, mail order, telemarketing, internet, etc)
 (MM/DD/YYYY)
 (MM/DD/YYYY)
 (MM/DD/YYYY)

PAYMENT INFORMATION

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(e.g., refund, credit, exchange or rebate)



ACKNOWLEDGE AND SUBMIT

Before you press the "Submit" button, please print a copy of the completed Consumer Complaint Form for your records. If you have supporting documentation regarding your complaint such as contracts, warranties, bills received, canceled checks, correspondence, etc., please mail or fax copies of these documents as well as a copy of the completed Consumer Complaint Form to the address at the bottom of this screen. DO NOT SEND ORIGINALS.

PLEASE READ THE FOLLOWING BEFORE SUBMITTING THIS FORM

In filing this form, I understand that the Division of Consumer Protection (DCP) is attempting to mediate my complaint. I also understand that if I have any questions concerning my legal rights or responsibilities, I should contact a private attorney. I hereby authorize the DCP to work with the appropriate government and private sector entities on my behalf, including requesting and reviewing appropriate documents, to attempt to resolve my dispute. I have no objection to the contents of this complaint being forwarded to the business or service person the complaint is directed against. The above complaint is true and accurate to the best of my knowledge.

This document is subject to disclosure under the Freedom of Information Law. The person or firm you are complaining about may receive a copy of this complaint.

New York State Department of State
Division of Consumer Protection
Consumer Assistance Unit
99 Washington Avenue
Albany, New York 12231-0001
Fax: 518-486-3936

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