Consumer Complaint Form (Internal)

For Office of Attorney General staff: use this internal form to enter consumer complaints received by phone, mail, or in person. Capture the complainant’s information and the details of their issue so the Bureau of Consumer Protection can process the matter.

"*" indicates required fields

Fields marked with (*) are required.

Source Type*

OAG Rep*

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OAG Rep*

First Last

Consumer Information

Veteran Status

Please check if you or an immediate family member is a member of the military or a veteran.

Senior Status

Please check if you are age 60 or older.

Your Information

Name*

First Last

Address*

Street Address Address Line 2 City State 5-Digit Zip Code

County*

Best Phone Number*

Alternative Phone Number (Optional)

Enter Email Confirm Email

By providing your email address, you agree to receive email communications from the Pennsylvania Office of Attorney General.

Age (optional)

Complaint Information

Please explain your complaint: Try to be brief, but be sure to tell WHAT happened, WHEN it happened and WHERE it happened. Be specific about any oral statements the business made to you, ESPECIALLY those that influenced you to deal with the company, including how you heard about the company. Describe events in the order in which they happened.

Business Name*

Business Email

Person to whom you spoke

Business Address

Street Address Address Line 2 City State 5-Digit Zip Code

Business Phone Number

Product or Service Purchased

Date Purchased

Choose month, day, and year of purchase

Purchase Price

Form of Payment

Other Form of Payment

Where and How Did You Sign the Contract (if applicable)

Where and How Did You Sign the Contract?

Legal Action

Please check if you are or have ever been involved in a legal action related to this complaint.

Please summarize in two sentences the result of the legal action.

Complaint Summary

What would you like the business to do to resolve your complaint?

If possible, please upload your contract, proof of payment, and other documentation to help us better understand your complaint. Accepted file types include jpg, gif, png, pdf. If you do not have a scanner, please upload photo of the documents. Please include any relevant emails or screen shots of text messages. If you prefer, you may email your documents to BC******@*************al.gov.

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Complaint File Uploads

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB, Max. files: 25.

What is your race or ethnicity?*

Other Agencies

Have you contacted other agencies?

Yes

Agencies Contacted and actions they took (if known)

PLEASE READ CAREFULLY The Attorney General cannot act as your private attorney. Please be advised that the information you provided may be shared with the party against which you have filed 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 file with our office and the information contained therein may be used to establish violations of Pennsylvania Law. You are authorizing the Bureau of Consumer Protection to contact the party against which you have filed a complaint in an effort to reach an amicable resolution. You further authorize the party against which you have filed a complaint to communicate with and provide information related to your complaint to the Bureau of Consumer Protection. Do you verify that the information provided is true and correct to the best of your knowledge or information and belief?

Complaint Submission Date*

Attorney General Sunday

Office of Public Engagement

Do Not Call List

Home Improvement Contractor Registration

Consumer Complaint Form (Internal)

Consumer Information

Your Information

Complaint Information

Other Agencies