Ellen F. Rosenblum
Attorney General
OREGON DEPARTMENT OF JUSTICE
CONSUMER
COMPLAINT
FORM
Frederick M. Boss
Deputy Attorney General
PLEASE NOTE T HE FOLLOWING:
Under Oregon Law, the Attorney General cannot act as your private attorney or give you legal advice. Deadlines may prevent you from
starting a lawsuit if you wait too long, you may wish to contact a private attorney. Filing this complaint does not change any deadlines.
1. PLEASE COMPLETE THIS FORM USING DARK INK. TYPE OR
PRINT CLEARLY.
2. RETURN THIS FORM ALONG WITH COPIES OF ALL SUPPORTING
DOCUMENTATION
. DO NOT SEND YOUR ORIGINALS!
INFORMATION ABOUT YOU FIELDS MARKED BY AN ASTERISK * ARE REQUIRED.
* First Name:
* Last Name:
* Mailing Address:
* City:
* State:
* Zip:
* Day Phone:
Cell:
Email:
-I would like to receive FRAUD & SCAM ALERTS. (Email address required)
-I am not requesting action on this complaint -I am over 65 years of age -I am under 30 years of age
-English is not my first language -I am a Veteran -I would like info on Veteran’s Benefits
D
EPENDING ON THE TYPE OF BUSINESS INVOLVED
,
THERE MAY BE OTHER STATE AGENCIES THAT CAN HELP
.
FOR A COMPLETE LIST OF AGENCIES, PLEASE VISIT - HTTP://WWW.OREGON.GOV/PAGES/A_TO_Z_LISTING.ASPX
Please provide information about the business or person in which you are submitting the complaint about.
Name of Business:
Mailing Address:
City:
State:
Zip:
Phone Number:
Business Email Address:
IF YOU PAID BY CREDIT CARD, THE CARD ISSUER MAY OFFER RELIEF OR PROTECTION. CONSIDER CONTACTING YOUR CREDIT CARD COMPANY.
$$ Money Lost:
Type of Service or Transaction:
-M otor Vehicles -Home & M ortgage -Phone, Internet & TV
-Sales, Scams & Fraud
-ID Theft & Data Breaches
-Credit, Loans & Debt
If your complaint is about TOWING, provide the License Plate #:
State: ___________ Plate #: ___________________________
If your complaint is about a WEBSITE, provide the Website
URL: ___________________________________________
If you have an ACCOUNT with this business, provide the
Account #: ______________________________________
Whom have you contacted concerning your Complaint?
Business Name: __________________________________
Other: __________________________________________
ARE YOU REPRESENTED? -YES -NO
DM# 8406566 | REV 07/14/19
ATTO RN EY S NAME: ________________________________
PHONE #: _______________________________________
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DETAILS OF COMPLAINT
(Attach additional pages if needed)
Oregon Department of Justice
Financial Fraud/Consumer Protection Section
1162 Court St., NE
Salem, OR 97301
-4096
By my signature below, I understand a) this complaint will become part of DOJs permanent records and is subject to Oregon’s Public
Records Law; b) this complaint may be released to the business or person about whom I am complaining; c) this complaint may be referred
to another governmental agency. I authorize any party to release to the DOJ any information and documentation relative to this complaint.
Signature: ____________________________________________________________ Date: _______________________________
You can submit your completed complaint and supporting documentation via, Mail, Email or Fax.
Mail Complaints to: Department of Justice | Financial Fraud/Consumer Protection Section | 1162 Court St. NE | Salem, OR 97301
Email Complaints to: help@oregonconsumer.gov | Fax Complaints to: (503) 378-5017 or (503) 378-8910
Consumer Hotline - Toll Free Area: (877) 877-9392 | Hours: 8:30am to 4:30pm M-F
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