PIU 2, Consumer Complaint Against a Business/Corporation

1 Consumer Complaint Against A business /CORPORATIONSTATE OF california department OF JUSTICEPIU 2 (Rev. 02/2012) PAGE 1 of 2 Kamala D. Harris Attorney GeneralPUBLIC INQUIRY UNIT (916) 322-3360/ (800) 952-5225 Toll Free - CA only TTY/TDD (800) 735-2929 ( california Relay Service) For TTY/TDD outside california contact your state's relay service number at AG Web Site: Form to: Public Inquiry Unit Office of the Attorney General Box 944255 Sacramento, CA 94244-2550 SECTION 1 - Your InformationMr. Ms. NameLast NameMIMailing AddressCityStateZip CodeCountry, if not Phone NumberCell Phone NumberMember of the Armed Forces?County of ResidenceE-Mail AddressSECTION 2 - Information About Company Against Which You Are ComplainingFull Name of CompanyMailing AddressCityStateZip CodeCountry, if not 's Internet Address (URL)E-Mail AddressTelephone NumberFax NumberSECTION 3 - Complaint InformationProduct, item or service involvedDate of TransactionAccount Number (if applicable)Total amount paidAmount in disputeHow was payment made:CashCheckCredit CardDebit CardMoney OrderWire TransferFinance AgreementOtherDid you sign a contract or lease?

2 YesNoWhere was the contract signed?Starting dateExpiration dateDate you complained to the company or individualBy MailBy TelephoneIn PersonPerson ContactedHis/Her phone numberResultsWhat result would you consider fair?Have you contacted another agency about this?YesNoIf yes, name of agencyDo you have an attorney in this case?YesNoIf yes, name of your attorneyAttorney's Phone NumberHas your Complaint been heard or is it scheduled to be heard in court?YesNoIf yes, where and when?If already heard, what was the result?PLEASE DESCRIBE Complaint ON REVERSE SIDECONSUMER Complaint Against A business /CORPORATIONSTATE OF california department OF JUSTICEPIU 2 (Rev. 02/2012) PAGE 2 of 2 Kamala D.

3 Harris Attorney GeneralSECTION 4 - Information About the TransactionHow was initial contact made between you and the business ?Person came to my homeI went to company's place of businessI received a telephone call from businessI telephoned the businessI received information in the mailI responded to a radio/television adI responded to a printed advertisementI responded to a website or e-mail solicitationI received a fax solicitationI attended a trade show or conventionOtherWhere did the transaction take place?At my homeAt company's place of businessBy mailOver the phoneVia computer (website or e-mail)Trade show or conventionOtherSECTION 5 - Important Information If the Complaint falls within the jurisdiction of another local, state or federal agency, you will be provided with appropriate referral information. In addition, the Complaint may be shared with other government agencies.

4 Please include copies of any supporting documents you may have, such as correspondence, contracts, invoices, receipts, etc. Do not send originals. This office does not have the authority to give private legal advice or provide private legal representation to individual 6 - Details of Complaint (use additional sheets if necessary)SECTION 7 - StatementI affirm that the information herein is true and accurate, and will sign a statement if may send this Complaint to the party named and I authorize that party to release any and all information with regard to this Complaint to the california department of :Date.