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CONSUMER COMPLAINT/INQUIRY FORM
 
  (Only New Complaints May Be Filed On-Line)
Please be aware of the following:
  • Complaints and inquiries become public records when they are submitted to the Attorney General's office, and under the Michigan Freedom of Information Act, copies may be subject to disclosure to anyone who asks for them.
  • A copy of the complaint will be sent to the business against whom the complaint is issued. An accurate company Fax number will expedite processing.
  • A copy of the complaint may be sent to other governmental agencies.
  • Please be particularly cautious with information containing your Social Security number, credit card account numbers, etc. for security purposes. If you believe it is necessary to submit such information, you should mail that information and the corresponding complaint instead of sending it electronically.
  • Do not use punctuation when providing names and addresses.

NOTE: Fields labelled in RED are required values. 


 
         
  Your Last Name:     First Name:       M.I.:  
  Your Street Address:     City:    
  Your State:   Zip Code:    
  Your County: Your Home Phone:  
  E-mail Address:     Your Work Phone:    Ext:  
  Retype your E-mail:   Fax Number:  
  Are you a veteran or active-duty service member?
 
 
         
  Company or Person?    
  Complainee Last Name:     Complainee First Name:    
  Company Name:        
  Street Address:     City:    
  State:   Zip Code:    
  County: Phone:   
  Fax Number:   E-mail Address:    
  Web Site Address:   Product Offered:  
    Is This Company or Person:
   



 
 
         
  Company or Person?    
  Complainee Last Name:   Complainee First Name:  
  Company Name:      
Street Address:   City:  
  State: Zip Code:  
  County: Phone:  
  Fax Number:   E-mail Address:  
  Web Site Address:      
 
 
 

If your complaint involves motor vehicle manufacturer warranties or non-dealer service contracts, please fill out this section. Most other auto-related complaints, including dealer complaints and complaints concerning automotive repairs and repair facilities, must be filed with the Department of State’s Bureau of Information Security, Regulatory Monitoring Division : 1-888-767-6424

    Vehicle Make, Model, and Year:  
    Vehicle VIN No.:  
 
 
         
    Incident Date:    
    Incident Time: :
    Incident Location:  
    Approximate Monetary Value:  
    Did you sign a contract?  
    Where did you sign this contract?  
    Is a court action pending?  
    Do you have an attorney representing you on this matter?  
    Are you willing to testify in court regarding this complaint?  
    Did you complain directly to the business? If so, who?  
    What was the response from the business?  
    If no complaint was given to the business directly, why?  
    Was this complaint filed with any other agencies? If so, who?  
  Do you think you were targeted for unfair treatment due to your status as a veteran or active-duty servicemember? If so, please provide more information in the Complaint Detail/Inquiry Information section below.
 
  Complaint Detail/Inquiry Information    

Describe your problem, what attempts you have made to correct it, and how you would like to have the problem resolved.
You have approximately 8-10 typed pages and you may paste text from word processing documents.
After you submit this form you will be provided with a postal mail address, and facsimile number, to which you may send documents.

 
         
 
 
 
 
   
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