Fillable Form 15: www.attorneygeneral.gov Consumer Complaint Form (Southeastern Community College)

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Form 15: www.attorneygeneral.gov Consumer Complaint Form (Southeastern Community College)

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KATHLEEN G. KANE
A
TTORNEY GENERAL
consumers@attorneygeneral.gov
www.attorneygeneral.gov
Consumer Complaint Form
Bureau of Consumer Protection
15
th
Floor, Strawberry Square
Harrisburg, PA 17120
1-800-441-2555 – PA ONLY
1-717-787-9707
Required fields are marked with an asterisk*
Your information:
Are you a veteran? Yes No
Are you on active duty? Yes No
Age Group:
Under 18
18-34
35-59
60-64
65 and older
Mr. Ms.
Mrs. Dr.
Name*
Address*
City*
State*
Zip Code*
Daytime Phone Number*
( )
Home Phone Number*
( )
Email Address
If completing this form on behalf of someone else, please complete the following information:
Are they a veteran? Yes No
Are they on active duty? Yes No
Age Group:
Under 18
18-34
35-59
60-64
65 and older
Mr. Ms.
Mrs. Dr.
Name*
Address*
City*
State*
Zip Code*
Daytime Phone Number
( )
Home Phone Number
( )
Email Address
Who is the complaint against?
Business/Person Name*
Phone Number:
( )
Name of the individual of whom you complained
Mailing Address
City
State
Zip Code
Product or Service Purchased
Date of Purchase
Purchase Price
Legal Representation:
Have you retained an attorney? Yes No
Attorney’s Name
Address
City
State
Zip Code
Daytime Phone Number
( )
Have you filed a legal
action?
Yes No
If yes, please state when:
Where was the legal action filed?
What decision was made?
Other Agencies:
Have you contacted other agencies? Yes No
What agencies were contacted?
What action was taken?
Complaint Information:*
Please explain your complaint. You may use additional sheets if necessary. Please print or type clearly.
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. Describe events in the order in which they happened. Attach COPIES of all
contracts, letters, receipts, canceled checks (front & back), advertisements or any other papers that relate
to your complaint.
What would you like the business to do to settle your complaint?
PLEASE READ CAREFULLY
THE ATTORNEY GENERAL CANNOT ACT AS YOUR PRIVATE ATTORNEY
As a law enforcement agency, the primary function of the Office of Attorney General is to represent the
public at large by enforcing laws prohibiting fraudulent or deceptive trade practices that impact the public
interest.
The Attorney General, through the Bureau of Consumer Protection (“Bureau”), provides a mediation
service to consumers where an attempt may be made to mediate individual consumer 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 filed. Additionally, your
complaint may be shared with or referred to other Governmental Law Enforcement or Regulatory
Agencies.
NOTE: We cannot mediate a matter which is or has been the subject of legal action.
Your complaint will be kept on file and may be used to establish violations of PA law.
By signing below:
1. I certify that the information provided in my complaint, including my identity and any
factual statements or allegations, are true and correct to the best of my knowledge,
information and belief.
2. I certify that I have read and understand the informational sheet about the mediation
process; and, further certify my understanding that the Bureau cannot provide individual legal
representation to me.
3. I certify that I have authorized the Bureau to contact the party(ies) against which I have
filed a complaint; and, that I further authorize the party(ies) against which I have filed a
complaint to communicate with and provide information related to my complaint to the
Bureau.
4. I certify that I have authorized the Bureau to transfer my complaint, and any or all
attachments related to it, to another federal, state, local or other agency which may have
jurisdiction over this matter.
YOUR SIGNATURE
DATE
Please include copies of all documents regarding your problem. Be sure to send COPIES, not
originals.
KATHLEEN G. KANE
A
TTORNEY GENERAL
consumers@attorneygeneral.gov
www.attorneygeneral.gov
Consumer Complaint Form
Bureau of Consumer Protection
15
th
Floor, Strawberry Square
Harrisburg, PA 17120
1-800-441-2555 – PA ONLY
1-717-787-9707
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 file a complaint with the Office 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 filed. 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 staff 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
notified 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 file number and
the name of the agent who will handle the mediation. Please keep your file number for future
reference when contacting this office.
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 file and keep it up-to-date, we request
communications from you and the business to be in writing.
• You will be notified by mail when we receive information regarding your case.
TO HELP US HELP YOU, PLEASE REFRAIN FROM CALLING FOR “STATUS REPORTS.”
If mediation efforts 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 offer
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 efforts to resolve the problem without success, contact the Office 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 first 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 specific information regarding the procedure for filing your dispute. You
must file your dispute with your credit card company, a complaint to the merchant or company that made
the charge is not sufficient. Even if you file a credit card dispute, you can still file a complaint with our
office.
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 file 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 efforts 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 satisfied 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 firm has a toll-free number.
If you have questions concerning the specific 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.
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Form 15: www.attorneygeneral.gov Consumer Complaint Form (Southeastern Community College)

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Completed 25 July 2020

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