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Consumer Complaint Form:

Your Information:
Name:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Age:
Please enter your email address below if you wish to receive a copy of this complaint.
Email:
Firm/Individual Complained Against Information:
Name:
Address:
City:
State:
Zip:
Phone:
Product or Service involved Information:
Product or Service involved
Did you sign a contract? Yes No
Have you contacted the company? Yes No
Have you consulted an attorney? Yes No
If so, who?
Is there a court action pending? Yes No
If so, where?
Estimate of dollars involved:
Your view as to a fair resolution of the matter:

PLEASE EXPLAIN THE CIRCUMSTANCES SURROUNDING YOUR COMPLAINT. YOU WILL BE CALLED UPON TO PROVIDE COPIES (NOT ORIGINALS) OF ANY CONTRACTS, SALES SLIPS, CANCELED CHECKS, ADVERTISEMENTS, CORRESPONDENCE, OR RELATED DOCUMENTS.

The information contained here is true and accurate to the best of my knowledge. I understand that the Arkansas Attorney General's office does not represent individuals in matters involving private disputes. I am, however, filing this complaint to notify the Attorney General's office of the activities of this party and for any other assistance which may be rendered. I give my permission for this complaint to be referred to other agencies when appropriate.

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