Scribd Logo
Upload

Welcome to Scribd!

  • 32 views

    Ocp Complaint Form

    Uploaded by

    Jim9870
    This document provides instructions for filing a consumer complaint with the Montgomery County Office of Consumer Protection in Rockville, Maryland. It outlines a 5-step process for submitting a complaint: 1) try to resolve directly with the company first, 2) complete the complaint form typing or printing clearly, 3) attach copies of relevant documents, 4) failure to provide documents may delay investigation, 5) do not send original documents. The form requests consumer and merchant information and details about the transaction, complaint, and resolution sought. It explains the complaint review and assignment process and authorizes the office to investigate on the consumer's behalf.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Ocp Complaint Form

    Uploaded by

    Jim9870
    32 views2 pages
    This document provides instructions for filing a consumer complaint with the Montgomery County Office of Consumer Protection in Rockville, Maryland. It outlines a 5-step process for submitting a complaint: 1) try to resolve directly with the company first, 2) complete the complaint form typing or printing clearly, 3) attach copies of relevant documents, 4) failure to provide documents may delay investigation, 5) do not send original documents. The form requests consumer and merchant information and details about the transaction, complaint, and resolution sought. It explains the complaint review and assignment process and authorizes the office to investigate on the consumer's behalf.

    Original Description:

    Office of Consumer Protection Form

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document provides instructions for filing a consumer complaint with the Montgomery County Office of Consumer Protection in Rockville, Maryland. It outlines a 5-step process for submitting a complaint: 1) try to resolve directly with the company first, 2) complete the complaint form typing or printing clearly, 3) attach copies of relevant documents, 4) failure to provide documents may delay investigation, 5) do not send original documents. The form requests consumer and merchant information and details about the transaction, complaint, and resolution sought. It explains the complaint review and assignment process and authorizes the office to investigate on the consumer's behalf.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    32 views2 pages

    Ocp Complaint Form

    Uploaded by

    Jim9870
    This document provides instructions for filing a consumer complaint with the Montgomery County Office of Consumer Protection in Rockville, Maryland. It outlines a 5-step process for submitting a complaint: 1) try to resolve directly with the company first, 2) complete the complaint form typing or printing clearly, 3) attach copies of relevant documents, 4) failure to provide documents may delay investigation, 5) do not send original documents. The form requests consumer and merchant information and details about the transaction, complaint, and resolution sought. It explains the complaint review and assignment process and authorizes the office to investigate on the consumer's behalf.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Montgomery County

    Office of Consumer Protection


    100 Maryland Avenue, Suite 330
    Rockville, Maryland 20850
    www.montgomerycountymd.gov/consumer
    T: 240.777.3636 F: 240.777.3768



    Internet
    Instructions For Using This Form
    1. Before using this form, complain directly to the company. If unsuccessful, then use this form.
    2. Please type or print clearly and complete the entire form. Illegible or incomplete forms may be returned to you.
    3. Attach photocopies of any papers involved in the transaction (including advertisements, contracts, receipts,
    statements, the front and back of canceled checks, correspondence, warranties, et cetera).
    4. Failure to provide paperwork may delay investigation of your complaint.
    5. DO NOT SEND ORIGINAL DOCUMENTS. We will not be responsible for originals.
    CONSUMER INFORMATION
    Your Name

    Daytime
    Telephone:
    Address

    Evening
    Telephone:
    City State Zip Code

    Cellular
    Telephone:
    E-mail:


    Facsimile:
    How did you learn about us?
    MERCHANT INFORMATION
    Individual/Business Name

    Business
    Telephone:
    Address

    Alternate
    Telephone:
    Post Office Box


    Facsimile:
    City State Zip Code

    E-mail:

    Other Contact Information:

    Website:

    Transaction Type: (Select from list.)
    Transaction date:

    Amount paid:

    Payment method:

    Did you sign a contract?

    If yes, please include a copy.
    Where was contract signed?

    Date contract signed:

    Date complained to business: Person contacted:

    Their title:

    Did they respond? If yes, date and nature of response (if response was in writing, include a copy):


    Court action pending? What court?

    Court date?

    Have you submitted this matter to an
    attorney or other agency?
    If yes, give the name, address and phone number of the attorney or agency:

    Describe Your Complaint and Provide Additional Information on Reverse
    PRINT
    First Name and Middle Initial Last Name
    Apt.
    County Website Another Agency Family/Friend Newspaper Radio Television Other:
    Required Field
    Select Transaction Type
    Specify "Other" Here:
    Select Payment Method
    Yes No
    Yes No
    Yes No
    Yes No



    DESCRIBE YOUR COMPLAINT. USE AN ATTACHMENT IF NECESSARY.




















    WHAT FORM OF RELIEF ARE YOU SEEKING? (Ex. Exchange, Repair, Money Back, etc.)
    REFUND AMOUNT REQUESTED/
    VALUE OF CLAIM:

    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 acknowledgment letter providing the name
    and phone number 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 complaint.
    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.

    Signature: _________________________________________________________ Date: _________________________

    HAVE YOU ATTACHED PHOTOCOPIES OF DOCUMENTS? DO NOT SEND ORIGINALS.
    Return to: Office of Consumer Protection
    New Complaint Unit
    100 Maryland Avenue, Suite 330
    Rockville, MD 20850

    Rev. 4/2010
    Print and sign completed form. Please return your signed form to the address below.

    You might also like