Your Information
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Bureau of Consumer Protection
15th Floor, Strawberry Square
Harrisburg, PA 17120
1-800-441-2555 – PA ONLY
1-717-787-9707
www.attorneygeneral.gov
Please check if you or an immediate family member is a member
of the military or a veteran.
Please check if you are age 60 or older.
NAME*
STREET ADDRESS*
CITY* STATE*
5-DIGIT ZIP CODE* COUNTY*
BEST PHONE NUMBER* ALTERNATIVE PHONE NUMBER
EMAIL AGE
Complaint Information
Fields marked with (*) are required.
BUSINESS NAME*
PERSON TO WHOM YOU SPOKE
BUSINESS ADDRESS
CITY* STATE
5-DIGIT ZIP CODE BUSINESS PHONE NUMBER
By providing your email address, you agree to receive email
communications from the Pennsylvania Oce of Attorney General.
PRODUCT OR SERVICE PURCHASED
DATE PURCHASED PURCHASED PRICE
FORM OF PAYMENT:
CREDIT CARD ATM/DEBIT CARD PREPAID CARD OTHER
WHERE AND HOW DID YOU SIGN THE CONTRACT (IF APPLICABLE):
HOME (PAPER CONTRACT) HOME (OVER THE PHONE)
HOME (ELECTRONIC SIGNATURE BUSINESS LOCATION
OTHER
WHERE AND HOW DID YOU SIGN THE CONTRACT?
PLEASE CHECK IF YOU ARE OR HAVE EVER BEEN INVOLVED IN A LEGAL ACTION
RELATED TO THIS COMPLAINT. IF SO, PLEASE SUMMARIZE IN TWO SENTENCES
THE RESULT OF THE LEGAL ACTION.
PLEASE EXPLAIN YOUR COMPLAINT: Try to be brief, but be sure to tell WHAT happened, WHEN it happened and
WHERE it happened. Be specic about any oral statements the business made to you, ESPECIALLY those that inuenced you
to deal with the company, including how you heard about the company. Describe events in the order in which they happened.
WHAT WOULD YOU LIKE THE BUSINESS TO DO TO RESOLVE YOUR COMPLAINT?
HAVE YOU CONTACTED OTHER AGENCIES? YES NO
IF YES, AGENCIES CONTACTED AND ACTIONS THEY TOOK (IF KNOWN)
Other Information
HOW DID YOU HEAR ABOUT US?
WHAT IS YOUR RACE OR ETHNICITY?
HISPANIC/LATINO
WHITE (NOT HISPANIC/LATINO)
BLACK/AFRICAN AMERICAN (NOT HISPANIC/LATINO)
NATIVE HAWAIIAN/PACIFIC ISLANDER
ASIAN
NATIVE AMERICAN
BIRACIAL
OTHER
PREFER NOT TO ANSWER
PLEASE READ CAREFULLY
e Attorney General cannot act as your private attorney. As a law enforcement agency, the primary function
of the Oce of Attorney General is to represent the public at large by enforcing laws prohibiting unfair or
deceptive practices. e Attorney General, through the Bureau of Consumer Protection, provides a mediation
service to consumers where an attempt may be made to mediate your individual consumer complaint if it falls
within the jurisdiction of the oce. Please be advised that the information you provide will be shared with
the party against which you have led a complaint. Additionally, your complaint may be shared with or
referred to other governmental law enforcement or regulatory agencies. Your complaint will also be kept on
le with our oce and the information contained therein may be used to establish violations of Pennsylvania
Law. Attached to this complaint form is an informational sheet which will help you in completion of the
complaint form and also will explain in greater detail the mediation process. By signing below, I authorize the
Bureau of Consumer Protection to contact the party(ies) against which I have led a complaint in an eort
to reach an amicable resolution. I further authorize the party(ies) against which I have led a complaint to
communicate with and provide information related to my complaint to the Bureau of Consumer Protection.
I verify that I have read and understand the informational sheet about this process; and, that the information
provided is true and correct to the best of my knowledge, information and belief.
YOUR SIGNATURE DATE
Please include copies of all documents regarding your problem.
Be sure to send COPIES, not originals.
WHEN SHOULD YOU FILE A COMPLAINT
If you are unable to resolve a problem with a business (see, “Problem-Solving Tips”, below), you may wish to le
a complaint with the Oce of Attorney General, Bureau of Consumer Protection (“Bureau”). You can download a
complaint form from our website at www.attorneygeneral.gov or you can call our toll-free number, 1.800.441.2555,
to have a form mailed to you.
The Bureau provides a mediation service to consumers where an attempt may be made to mediate individual
complaints which fall within the Bureau’s jurisdiction. The information you provide will be used in an attempt to
resolve your complaint and will be shared with the party(ies) against which the complaint is led. Additionally, your
complaint may be shared with or referred to other governmental law enforcement or regulatory agencies.
NOTE: (1) Participation in the mediation process is voluntary and we cannot compel a business to cooperate; and
(2) We cannot mediate a matter that is already or has been the subject of legal action.
When we receive your completed complaint form, it will be reviewed by our sta and, depending on the nature of
the complaint, one of the following courses of action may be taken.
We may refer your complaint to a local, state or federal agency, which has primary jurisdiction
over the subject matter. If your complaint is referred to such an agency or organization, you will
be notied by mail of its name and address, so you may follow up on your complaint.
If your complaint falls with the Bureau’s jurisdiction, we may attempt to initiate our voluntary
mediation process with the business, in which case you will receive a letter with your le number
and the name of the agent who will handle the mediation. Please keep your le number for
future reference when contacting this oce.
NOTE: Because of the volume of complaints the Bureau receives, it may take some time before we review and
process your complaint. We ask for and appreciate your patience during this time.
NOTE: In order to document your complaint le and keep it up-to-date, we request communications from you and
the business to be in writing.
You will be notied by mail when we receive information regarding your case.
TO HELP US HELP YOU, PLEASE REFRAIN FROM CALLING FOR “STATUS REPORTS.”
If mediation eorts are not successful, you may be advised to seek relief either through a private attorney or through
Magisterial District Court. The Bureau cannot provide you with private legal counsel or oer legal advice. The
Bureau represents the public at large in its enforcement of the Unfair Trade Practices and Consumer Protection Law
(“Consumer Protection Law”). The Consumer Protection Law does provide individual consumers with the ability to
bring a private action, citing unfair and deceptive business practices.
PROBLEM-SOLVING TIPS
It is helpful for you to try to resolve your own complaint before contacting the Bureau. However, if you have
exhausted your eorts to resolve the problem without success, contact the Oce of Attorney General promptly for
assistance.
NOTE: If your claim involves a dispute of charges placed on your credit card, or billing statement or if a merchant
has promised to reverse or credit your charge card but has failed to do so, you must act quickly to preserve your
right to challenge a charge. Under the Federal Fair Credit Billing Act, your credit card company must receive
a written dispute notice from you within 60 days after the rst bill containing the disputed charge was mailed to
you. The Bureau cannot dispute this charge for you. Look at the back of your credit card statement for specic
information regarding the procedure for ling your dispute. You must le your dispute with your credit card
company, a complaint to the merchant or company that made the charge is not sucient. Even if you le a credit
card dispute, you can still le a complaint with our oce.
IDENTIFY THE PROBLEM
Before you complain to a company, be sure to identify the problem, what (if anything) you have already done to
resolve the problem and what you think is a fair settlement. For example, do you want your money back? Would
you like the product repaired? Do you want the product exchanged?
GATHER RECORDS
Start a le about your complaint. Include copies of sales receipts, repair orders, warranties, canceled checks, and
contracts which will back up your complaint and help the company solve your problem.
Go to the place you made the purchase. Contact the person who sold you the item or performed the service. Calmly
and accurately explain the problem and what action you would like taken. If that person is not helpful, ask for the
supervisor or manager and restate your case. A large percentage of consumer problems are resolved at this level.
Chances are, yours will be too.
Allow each person you contact time to resolve your problem before contacting someone else.
Keep a record of your eorts and include the names of those you spoke with and what was done about the problem.
Save copies of any letters you send to the company, as well as letters sent to you.
WRITING A COMPLAINT LETTER
The letter should include your name, address, home and work telephone numbers, and the account number, if
appropriate.
Make your letter brief and to the point. Specify all the important facts about your purchase, including the date
and place you made the purchase and any information you can give about the product, such as the serial or model
number. If you are writing to complain about a service you received, describe the service and who performed it.
State exactly what you want done about the problem and how long you are willing to wait to resolve it. Have
reasonable expectations.
Include copies of all documents regarding your problem. Be sure to send COPIES, not originals.
Don’t write an angry, sarcastic, or threatening letter. The person reading your letter probably was not responsible for
your problem, but may be very helpful in resolving it.
Type your letter if possible. If it is handwritten, make sure it is neat and easy to read.
Keep a copy of all correspondence to and from the company, as well as a copy of your complaint.
OTHER ASSISTANCE
If you are not satised with the response, don’t give up. If the company operates nationally or the product
is a national brand, call or write a letter to the person responsible for consumer complaints at the company’s
headquarters, e.g., the company’s public relations representative or president. Many companies have toll-free
telephone numbers, often printed on the product. Before telephoning a company long distance, check to see if the
rm has a toll-free number.
If you have questions concerning the specic application or interpretation of the law, you should consult a private
attorney. If you do not have an attorney, you can call your county lawyer referral service or your county bar
association. Other agencies may be accessed through the blue pages of your telephone director.
The Bureau is charged with identifying patterns of business practices which may violate the Consumer Protection
Law. Even if you have resolved your complaint, you can forward a statement regarding your experience, with
attached documents, for the Bureau’s reference.
Thank you for bringing this matter to our attention. We hope we can be of assistance to you.
