2601 N Lamar Blvd
Austin, TX 78705
occc.texas.gov
CONSUMER COMPLAINT FORM
512-936-7600
Fax: 512-936-7610
CONSUMER INFORMATION
Your
Full Name
Address
City/State/Zip
Are you age 18 or older ?
Yes No E-mail Address
Home Phone
( ) Work Phone ( )
The best place and time to reach you from 8 a.m. to 5 p.m. is at ______ (work or home) at (time)
COMPANY OR INDIVIDUAL ABOUT WHOM YOU ARE COMPLAINING
Company Name
Address
City/State/Zip
Telephone ( )
List the names of any individuals with whom you have had contact
ACCOUNT INFORMATION
Your account name (as company has it)
Your account number (as company has it)
Did you sign any papers? Yes No
Were they signed at your home? Yes No
Were you given a copy? Yes No
COMPLAINT INFORMATION
All complaints and accompanying information are presumed to be open records unless excepted pursuant to TEX. GOVT. CODE §
552.101 et seq. Information and records not excepted must, by law, be given to anyone who requests them.
Have you contacted an attorney relative to this complaint? Yes No
Is there a court action pending? Yes No
How did you find out about the OCCC ?
Have you tried to resolve the complaint issue with the company described above? Yes No
If you have, what was their response to your concerns?
Please provide a written explanation of your complaint by describing a timeline of events and noting dates of
transactions, interactions, the names of individuals, and names of businesses involved. If you need more space, you
may provide it as an attachment. Enclose copies of documents that are relevant to your issue.
What do you believe would be a fair resolution to this matter?
I agree that the information provided within this complaint (and any attachments) is correct to the best of my knowledge. If I
am filing this complaint on behalf of another, I affirm that I have the complainant's permission to do so. I give the OCCC
permission to discuss or provide a copy of this information to the individual or company I am complaining about. If my
complaint concerns violation of state or federal law outside the OCCC's jurisdiction, the OCCC may forward it to the appropriate
agency.
Signature Date
Note: You may either mail this form or return it as an attachment via e-mail. A signature is not required for those forms returned via e-mail, however,
choosing to return the form via e-mail will also be considered an affirmation of the statements above.
Return to: Office of Consumer Credit Commissioner • 2601 N Lamar Blvd • Austin TX 78705 •E-mail: consumer.complaints@occc.texas.gov