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Montgomery County, MD
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Office of Consumer Protection
OCP Complaint Application
Instructions:
1. Before submitting a complaint, please complain directly to the company. If the company does not resolve the issue, submit a complaint online.
2. Please complete the entire form. Required fields are marked with an asterisk (*).
3. Supporting documents are submitted separately. Send copies of any documents involved in the transaction (including advertisements, contracts, receipts, statements, the front and back of canceled checks, correspondence, warranties, etc.) by e-mail, fax or hard copy. Instructions are provided below. Include your case number on all correspondence.
4. Failure to submit paperwork may delay investigation of your complaint.
5. Do not send any original documents. We will not be responsible for originals.
* = Required Field
Consumer Information
Title
Select One
Mr.
Mrs.
Ms.
Dr.
Prof.
Sr.
Sra.
Srta.
First Name
*
Middle Name / Initial
Last Name
*
Address
*
Apt./Unit
City
*
State
*
Select One
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NV
NH
NJ
NM
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Postal / Zip Code
*
Country
*
United States
United Kingdom
Australia
Canada
France
New Zealand
India
Brazil
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Democratic Republic of the Congo
Republic of the Congo
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Telephone Day
*
Ext.
Telephone Evening
Ext.
Telephone Cellular
Fax
Email
Please check "Yes" to receive consumer alerts and news via email.
*
Yes
No
For statistical purposes, please tell us if you are 65+ years of age.
*
<65
65+
Decline
Individual/Merchant Information
Please search for Individual or Merchant and select it from the drop down. If you cannot find the Individual or Merchant (No Match Found), click the “Add New Individual/Merchant” button to add the new Individual or Merchant.
Individual or Merchant Name
Complaint Information
Describe your complaint. (Do not include sensitive personal data such as credit card numbers, bank account numbers, etc.)
*
Transaction Type
*
Select One
Automotive
Communication
Employment/Talent/Modeling Agencies
Entertainment
Financial/Credit
Fitness/Sports/Karate Schools
Food
Home Improvement Companies
Investment Opportunities
Landlord/Tenant
New Home Builder
Professional Services
Retail - Sale, Service, Repair, Rental
Scams
Towing
Transportation
Utilities
Vacation/Travel
Payment Method
*
Select One
Cash
Check
Credit Card
Debit Card
Loan/Financed
None/Not Applicable
Other
Transaction Date
Did you sign a contract? If Yes, please mail in a copy of the contract.
*
Yes
No
Date Contract Signed
Date First Complained To Business. If there are additional dates, please indicate in 'Describe your complaint...' above.
*
Name of Person Contacted
*
Title of Person Contacted:
Did s/he respond?
*
Yes
No
Is there a pending court action?
*
Yes
No
What Court?
*
Court Date:
*
Have you submitted this matter to an attorney or another agency?
*
Yes
No
Refund Amount Requested/Estimated Value of Claim:
*
What form of relief are you seeking? (Exchange, Repair, Money Back, etc.)
*
How did you learn about us?
*
Select One
Advertisement
Attorney/Lawyer/Legal Service Provider
Consumer Ed Event
County Website
Friend/Word of Mouth
Internet Search
MC311/Other Government Agency
Newspaper
Previous Use
Radio
Social Media/Community Listserv
TV
Other
Language Preference
*
Select One
English
Akan
Amharic
Arabic
Assamese
Awadhi
Azerbaijani
Balochi
Belarusian
Bengali
Bhojpuri
Burmese
Cebuano (Visayan)
Chewa
Chhattisgarhi
Chittagonian
Czech
Deccan
Dhundhari
Dutch
Eastern Min
French
Fula
Gan Chinese
German
Greek
Gujarati
Haitian Creole
Hakka
Haryanvi
Hausa
Hiligaynon (Visayan)
Hindi
Hmong
Hungarian
Igbo
Ilocano
Italian
Japanese
Javanese
Jin
Kannada
Kazakh
Khmer
Kinyarwanda
Kirundi
Konkani
Korean
Kurdish
Madurese
Magahi
Maithili
Malagasy
Malayalam
Malaysian/Indonesian
Mandarin (entire branch)
Marathi
Marwari
Mossi
Nepali
Northern Min
Odia (Oriya)
Oromo
Pashto
Persian
Polish
Portuguese
Punjabi
Quechua
Romanian
Russian
Saraiki
Serbo-Croatian
Shona
Sindhi
Sinhalese
Somali
Southern Min
Spanish
Sundanese
Swedish
Sylheti
Tagalog/Filipino
Tamil
Telugu
Thai (excl. Lao)
Turkish
Turkmen
Ukrainian
Urdu
Uyghur
Uzbek
Vietnamese
Wu (inc. Shanghainese)
Xhosa
Xiang (Hunnanese)
Yoruba
Yue (incl. Cantonese)
Zhuang
Zulu
Electronic Signature Agreement
READ AND UNDERSTAND THE FOLLOWING BEFORE SIGNING BELOW:
Once we receive your complaint, it will be reviewed for jurisdiction and to determine the best course of action. If we determine that there is a more suitable agency to handle your dispute, we will make an appropriate referral and advise you in writing. Otherwise, your complaint will be assigned to an investigator. We will send you an acknowledgement letter providing the name and phone number of of your investigator, and the case number assigned to the complaint.
Please include your case number on any future correspondence you send to us.
I authorize the Office of Consumer Protection and/or its representative to make inquiries on my behalf, into any and all files or accounts that may be necessary to investigate the complaint I have filed with the agency. Further, I authorize the office of Consumer Protection to use and supply, on my behalf, any private information included in this document.
I understand that a copy of this form may be sent to the business against which I have filed this complaint. I understand that this complaint is a public document and is available for inspection by the public and the media.
I do solemnly declare and affirm under the penalties of perjury that the contents of my complaint are true and correct.
By entering your full name in the “Signature (Type your full name)” field, you are signing this Complaint Form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Complaint Form.
Signature (Type your full name):
*
You will be able to upload supporting documents after you click the 'Submit' button below."
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