Fillable A BUSINESS/CORPORATION CONSUMER COMPLAINT AGAINST (California)

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A BUSINESS/CORPORATION CONSUMER COMPLAINT AGAINST (California)

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CONSUMER COMPLAINT AGAINST
A BUSINESS/CORPORATION
STATE OF CALIFORNIA DEPARTMENT OF JUSTICE
PIU 2
(Rev. 04/2021)
PAGE 1 of 3
Rob Bonta
Attorney General
PUBLIC INQUIRY UNIT
(916) 210-6276 / (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 http://www.fcc.gov/cgb/dro/trsphonebk.html
AG Web Site: http://www.oag.ca.gov/
Mail Form to:
Public Inquiry Unit
Office of the Attorney General
P.O. Box 944255
Sacramento, CA 94244-2550
SECTION 1 - Your Information
First Name Last Name
MI
Mailing Address
County of Residence Country, if not U.S.
SECTION 2 - Information About Company Against Which You Are Complaining
Full Name of Company
Mailing Address
City State
Zip Code Country, if not U.S.
Company's Internet Address (URL) E-Mail Address
Telephone Number
Fax Number
SECTION 3 - Complaint Information
Product, item or service involved
Date of Transaction
Account Number (if applicable)
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 sign a contract or lease?
Yes No
Where was the contract signed?
Starting date
Expiration date
Date you complained to the company or individual
By Mail By Telephone
In Person
Person Contacted
His/Her phone number
Results
What result would you consider fair?
Have you contacted another agency about this?
Yes
No
If yes, name of agency
Do you have an attorney in this case?
Yes
No
If yes, name of your attorney
Attorney's Phone Number
Has your complaint been heard or is it scheduled to be heard in court? Yes
No
If yes, where and when?
If already heard, what was the result?
PLEASE DESCRIBE COMPLAINT ON NEXT PAGE
Please read the Information Collection, Use and Access
notice on page 3.
E-Mail Address
State
City
Zip Code
Day Phone Number
Cell Phone Number
13-17 18-19 20-29 80 & over12 & under 30-39 40-49 50-59 60-69 70-79
Are you a member of the U.S. Armed Forces
or a dependent? (optional)
Age Range (optional):
Yes
No
Do you have a disability?
(optional)
Yes
No
If yes, please specify your military status:
Active Duty Service Member
Dependent Spouse - Service Member
Dependent Child/Other - Service Member DoD Civilian
Dependent Spouse - DoD Civilian
Dependent Child/Other - DoD Civilian
Military Retiree/Veteran
Reserve Not on Active Duty/National Guard
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CONSUMER COMPLAINT AGAINST
A BUSINESS/CORPORATION
STATE OF CALIFORNIA DEPARTMENT OF JUSTICE
PIU 2
(Rev. 04/2021)
PAGE 2 of 3
Rob Bonta
Attorney General
SECTION 4 - Information About the Transaction
How was initial contact made between you and the business?
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 a radio/television ad
I responded to a 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 convention
Other
SECTION 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.
• 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 consumers.
SECTION 6 - Details of Complaint (use additional sheets if necessary)
SECTION 7 - Statement
I affirm that the information herein is true and accurate, and will sign a statement if needed. YES
NO
You may send this complaint to the party named. By filing this complaint, I hereby give the business complained about my consent to
communicate, including disclosure of non-public personal information, with the Office of the Attorney General about any and all matters
connected with this complaint.
YES NO
Signature:
Date:
CONSUMER COMPLAINT AGAINST
A BUSINESS/CORPORATION
STATE OF CALIFORNIA DEPARTMENT OF JUSTICE
PIU 2
(Rev. 04/2021)
PAGE 3 of 3
Rob Bonta
Attorney General
Collection and Use of Personal Information. The Public Inquiry Unit in the Department of Justice collects the
information requested on this form as authorized by Government Code Sections 11180, 11181, and 11182. The
Public Inquiry Unit uses this information to review your complaint. In addition, any personal information collected
by state agencies is subject to the limitations in the Information Practices Act and state policy. The Department of
Justice's general privacy policy is available at http://oag.ca.gov/privacy-policy.
Providing Personal Information. You do not have to provide the personal information requested. If you do not
wish to provide personal information, such as your name, home address, or home telephone number, you may
remain anonymous. In that case, however, we may not be able to contact you or help resolve your complaint.
Access to Your Information. You may review the records maintained by the Public Inquiry Unit in the Department
of Justice that contain your personal information, as permitted by the Information Practices Act. See below for
contact information.
Possible Disclosure of Personal Information. In order to follow up on your complaint, we may need to share the
information you give us with the party you complained about or with other government agencies.
The information you provide may also be disclosed in the following circumstances:
-With other persons or agencies where necessary to perform their legal duties, and their use of your
information is compatible and complies with state law, such as for investigations or for licensing,
certification, or regulatory purposes;
-To another government agency as required by state or federal law;
-For law enforcement purposes, including the investigation and prosecution of violations of federal, state
or local laws.
Contact Information. For questions about a written comment or complaint that you submitted to the Public
Inquiry Unit, please fill-out and submit our online form, available at:
http://oag.ca.gov/contact/general-comment-question-or-complaint-form
Please specify in the "Your Comments" section the specific Public Inquiry Unit record that you are seeking. Or you
may mail your request to Analyst, Public Inquiry Unit, Office of the Attorney General, P.O. Box 944255,
Sacramento, CA 94244-2550. In addition, if you are seeking records maintained by another Department of Justice
program, you should contact that program directly.
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A BUSINESSCORPORATION CONSUMER COMPLAINT AGAINST (California)

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Completed 26 April 2022

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