Fillable Form 9: CONSUMER COMPLAINT STATE OF WEST VIRGINIA (State of West Virginia)

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Form 9: CONSUMER COMPLAINT STATE OF WEST VIRGINIA (State of West Virginia)

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The Form 9: CONSUMER COMPLAINT STATE OF WEST VIRGINIA (State of West Virginia) form is 3 pages long and contains:

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  • 43 check-boxes
  • 36 other fields

Country of origin: US
File type: PDF

U.S.A. forms for State of West Virginia

BROWSE STATE OF WEST VIRGINIA (WV) FORMS

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9
Mr. 9 Mrs. 9 Ms.
www.wvago.gov E-Mail: consumer@wvago.gov
CONSUMER COMPLAINT
1. PARTY COMPLAINING 2. COMPLAINT AGAINST
Name: Business Name:
Mailing Address: Address:
City: State: City: State:
County: Zip Code: County: Zip Code:
Home Telephone: Telephone:
Work Telephone: Name of person you dealt with:
Cell Telephone:
Title:
Email:
Best time to contact me:
3. Date of purchase or transaction:
4. Product or service involved:
5. Price and terms of payment:
6. Type of payment:
9
Cash
9
Loan
9
Credit Card
9
Wire Transfer
Please check
9
Check
9
Installment
9
Debit Card
9
Western Union
all that apply 9
Other
9
PayPal
7. A. If your purchase was
financed
, please provide the name, address, and telephone number of the
finance company:
B. If your complaint concerns
product defects or repairs
, please provide the name, address, and telephone number of
the
manufacturer:
C. If your complaint is against a
debt collector
, please provide the name, address, and telephone number of the
original
creditor:
PLEASE CONTINUE TO THE NEXT PAGE
STATE OF WEST VIRGINIA
OFFICE OF THE ATTORNEY GENERAL
CONSUMER PROTECTION DIVISION
1-800-368-8808 or 304-558-8986
THIS IS AN
ELECTRONIC COPY
8. First contact between you and individual/business:
9
Person came to my home
9
Telephoned the business/individual
9
Went to place of business
9
Received telephone call from business/individual
9
Received information in the mail
9
Email
9
Responded to a radio – TV – printed advertisement
9
Internet
Name and address of publication – TV – radio station where offer was advertised:
Have you contacted the publication, TV or radio station? ............
9
Yes
9
No
9. Where did the purchase/transaction take place?
9
At my home
9
At the place of business
9
Over the telephone
9
By mail
9
There was no transaction
9
Internet
9
Wire Transfer
9
Other
10. Have you contacted the business about your complaint? ............
9
Yes
9
No
11. Have you filed this complaint with any other agency or organization? . . .
9
Yes
9
No
If Yes - Identify organization:
What action was taken?
12. Describe any legal action you have taken:
13. Did you sign a contract?...................
9
Yes
9
No
14. Did you receive a copy of the contract? .......
9
Yes
9
No
15. Did you receive a 3-Day Right to Cancel? .....
9
Yes
9
No
16. Is there a warranty involved? ...............
9
Yes
9
No
Attach copies of all documents – front and back – related to the transaction.
If statements or promises were not in writing, describe them in Question 17.
If you need additional space to tell what happened,
please continue on a separate page and attach it to your complaint.
PLEASE CONTINUE TO THE NEXT PAGE
17. Please describe your complaint in detail:
18. How do you want your complaint resolved?
The information you provide will be used in efforts to resolve your problem and may be shared with the party
complained against. It may also be used to enforce applicable state laws.
I hereby authorize any party to whom the Attorney General directs this complaint to release any and all information
about this matter, including account information, to the Attorney General’s Office.
I certify that all information on this form is true and accurate to the best of my knowledge and belief, and that I have
the legal authority to submit this claim.
SIGNATURE (Required) DATE
Return this form and copies of your papers to: Office of the Attorney General
Consumer Protection Division
PO Box 1789
Charleston, WV 25326-1789
Revised: January 14, 2013
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Form 9: CONSUMER COMPLAINT STATE OF WEST VIRGINIA (State of West Virginia)

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Completed 26 May 2022

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