New York Attorney General Complaint Form

[Credit Expert]

New York Attorney General Complaint Form

New-York-Attorney-General-Complaint-Form-www.CreditAgenda.com.pdf

New York Attorney General Complaint Form

(103.29 KiB) Downloaded 18 times

[Credit Expert]

Test to see how text from PDF Looks

ATTORNEY GENERAL ANDREW M. CUOMO
STATE OF NEW YORK COMPLAINT FORM

OFFICE OF THE ATTORNEY GENERAL
Consumer Hotline For Hearing Impaired
BUREAU OF CONSUMER FRAUDS AND PROTECTION 1 (800) 771-7755 TDD (800) 788-9898
120 Broadway, 3rd Floor http://www.oag.state.ny.us
New York, NY 10271-0332

Tel. (212) 416-8345 Fax (212) 416-8787

1. PLEASE BE SURE TO COMPLAIN TO THE COMPANY OR INDIVIDUAL BEFORE FILING.
2. PLEASE TYPE OR PRINT CLEARLY IN DARK INK.
3. YOU MUST COMPLETE THE ENTIRE FORM. INCOMPLETE OR UNCLEAR FORMS WILL BE RETURNED TO YOU.
4. MAKE SURE YOU ENCLOSE COPIES OF IMPORTANT PAPERS CONCERNING YOUR TRANSACTION.
CONSUMER


YOUR NAME HOME TELEPHONE NUMBER
STREET ADDRESS BUSINESS TELEPHONE NUMBER
CITY/TOWN COUNTY STATE ZIP


COMPLAINT

NAME OF SELLER OR PROVIDER OF SERVICES NAME OF OTHER SELLER OR PROVIDER OF SERVICES

STREET ADDRESS STREET ADDRESS
CITY/TOWN STATE ZIP CITY/TOWN STATE ZIP
TELEPHONE NUMBER TELEPHONE NUMBER
DATE OF TRANSACTION COST OF PRODUCT OR SERVICE
$

HOW PAID (Check those which apply)

G Cash G Check G Credit Card G Other

DID YOU SIGN A CONTRACT?

G Yes G No

WHERE DID YOU SIGN THE CONTRACT? DATE SIGNED

WAS PRODUCT OR SERVICE ADVERTISED?

G Yes G No

WHERE WAS IT ADVERTISED? DATE ADVERTISED

TYPE OF COMPLAINT (e.g. car, mail order, etc. Use the reverse side of this form to provide details)

DATE YOU COMPLAINED TO THE COMPANY OR INDIVIDUAL

G By Mail G By Telephone G In Person

PERSON CONTACTED JOB TITLE

NATURE OF RESPONSE DATE OF RESPONSE

HAS MATTER BEEN SUBMITTED TO ANOTHER AGENCY OR ATTORNEY? (If “Yes,” give name and address)

G Yes G No

IS COURT ACTION PENDING? (Please describe as necessary)

G Yes G No

ADDITIONAL INFORMATION

MANUFACTURER OF PRODUCT PRODUCT MODEL OR SERIAL NUMBER

ADDRESS WARRANTY EXPIRATION DATE

DID BUSINESS ARRANGE FINANCING? (If “Yes,” give name and address of bank or finance company)

G Yes G No

PLEASE DESCRIBE COMPLAINT ON REVERSE SIDE

CNS 001NY (1/07)

BRIEFLY DESCRIBE YOUR COMPLAINT

WHAT FORM OF RELIEF ARE YOU SEEKING? (e.g., exchange, repair or money back, etc.)

WHO REFERRED YOU TO THIS OFFICE?

READ THE FOLLOWING BEFORE SIGNING BELOW

PLEASE ATTACH TO THIS FORM PHOTOCOPIES of any papers involved (contracts, warranties, bills received,
canceled checks,

correspondence, etc.). DO NOT SEND ORIGINALS.

NOTE: In order to resolve your complaint, we may send a copy of this form to the person or firm about whom you
are complaining.

In filing this complaint, I understand that the Attorney General is not my private attorney, but represents the public
in enforcing laws designed to protect the public from misleading or unlawful business practices. I also understand that if I have any questions concerning my legal rights or responsibilities, I should contact a private attorney. I have no objection to the contents of this complaint being forwarded to the business or person the complaint is directed against.

The above complaint is true and accurate to the best of my knowledge.

I also understand that any false statements made in this complaint are punishable as a Class A Misdemeanor under
Section 175.30 and/or Section
210.45 of the Penal Law.

Signature: Date:

HAVE YOU ENCLOSED COPIES OF IMPORTANT PAPERS?

Return to: Office of the Attorney General
Bureau of Consumer Frauds and Protection
120 Broadway, 3rd Floor
New York, NY 10271-0332