Consumer Complaint Form

* Required Fields
Consumer Information
* Name
Address
City
State
Zip Code
County
Home Phone
Work Phone
Cell Phone
Age
* Email

Company Complained Against Information
* Company Name
Company Address
Company City
Company State
Company Zip Code
Company Phone
Company Email
Company Website

Transaction Information
* Product or Service
Date of Transaction
Estimate of dollars involved

* Please explain the circumstances surrounding your complaint.


Your view as to a fair resolution of the matter.

Do you have supporting documentation? Yes \| No
Supporting documentation includes contracts, sales slips, cancelled checks, advertisements, correspondence, or related documents associated with this complaint. After reviewing your complaint, we may ask you to send copies (not originals) of the supporting documentation.

The information contained here is true and accurate to the best of my knowledge. I understand that the Arkansas Attorney General's office does not represent individuals in matters involving private disputes. I am filing this complaint to notify the Attorney General's office of the activities of this party and for any other assistance which may be rendered, including attempted resolution of my complaint or referral to another appropriate entity. I understand that a copy of what I submit to the Attorney General's Office will be provided to the party I am complaining against in an effort to resolve the complaint. I authorize the party against which I have filed a complaint to communicate with and provide information to the Arkansas Attorney General's Office. I also understand that my complaint may be referred to other agencies. I acknowledge that the Attorney General will keep a record of this complaint and that it may be deemed a public record subject to disclosure under the Arkansas Freedom of Information Act.

Consumer Complaint Form

Consumer Information

Company Complained Against Information

Transaction Information