Consumer Complaint Form

Please fill out the online form below. If you prefer to print the form and mail it to us, please click here.

Please check one of the following notice types:

Notice of a potential complaint against a company and/or individualReport an unlicensed company and/or individualOther

Please provide the name and address of the company and/or individual(s):

Name of Individual(s) Name of Company Address City State ZIP

Please provide a brief description of the reason/incident that prompted the filing of this notice in the area below.

Please include supporting documentation such as pictures, signed contracts, etc.

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Your Contact Information:

Your Name* Your Email* Your Address* City State ZIP Telephone* Date

*All personal information submitted will remain confidential. Issues related to complaint must have occurred within the past 12 months for it to be considered.