North Carolina Department of Justice
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File a Complaint
Complaint Form
File a Complaint
* indicates a mandatory field
Your Information
Prefix:
Mr.
Ms.
Mrs.
* First Name:
Middle Initial:
* Last Name:
* Mailing Address:
* City:
* State:
* Zip Code:
Country, if not US:
Day Phone Number (including area code):
Evening Phone Number (including area code):
Cell Phone Number (including area code):
Fax Number (including area code):
County of Residence:
Email Address:
Information About Company Against Which You Are Complaining
* Full name of company:
Address:
City:
State:
Zip Code:
Country, if not US:
Company’s internet address (URL):
* Telephone number, including area code:
Fax number, including area code:
Complaint Information (complete any blocks which apply to your complaint)
Product, item, or service involved:
Date of purchase, service, contract:
Now
Manufacturer or brand:
Model:
Account number:
Do not submit credit card or bank account numbers through this form. If you need to provide that information as part of your complaint, please mail it to us instead.
Serial number:
Did you sign a contract or a lease?:
Yes
No
Start Date:
Now
End Date:
Now
Total amount paid:
Amount in dispute:
How was payment made::
Cash
Check
Credit card
Debit card
Money order
Wire transfer
Finance agreement
Other
Did you buy an extended service contract?:
No
Yes
If yes, name of company responsible for extended service contract or warranty:
Information About the Transaction
How was initial contact made between you and the:
Person came to my home
I went to company’s place of business
I received a telephone call from business
I telephoned the business
I received information in the mail
I responded to radio/television ad
I responded to printed advertisement
I responded to a Website or e-mail solicitation
I received a fax solicitation
I attended a trade show or convention
Other
Where did the transaction take place?:
At my home
At company’s place of business
By mail
Over the phone
Via computer (website or e-mail)
Trade show or hotel
Other
Details of Complaint
* Details:
Limit of 2500 characters
Resolution Attempts You Have Made
Have you contacted the company with your complaint?:
No
Yes
If yes, name of person most recently contacted:
His/her phone number, incl. area code:
Results:
* What resolution would you consider fair?:
Do you have an attorney in this case?:
No
Yes
If yes, name of your attorney:
Attorney’s number, incl. area code:
Has your complaint been heard or is it scheduled to be heard in court?:
No
Yes
If yes, where and when?:
If already heard, what was the result?:
* Will you be submitting documentation by mail or fax?:
Select One
No
Yes
Please attach up to four supporting documents in pdf, doc, docx or txt format. You may also mail supporting documents to us.
Attachment 1:
Upload:
Attachment 2:
Upload:
Attachment 3:
Upload:
Attachment 4:
Upload:
Please print a copy of your completed form to mail in with any supporting documents and a copy for your records. Please note that the printed copy may not include all of the information included in the details of complaint box.
After you’ve completed the form and printed copies, please hit submit to send your complaint to the Consumer Protection Division.