Consumer Complaint Form
Thank you for accessing the Office of the Attorney General's website.
Please fill out the complaint form below in detail.

Complaint Reported By:
(your name and address goes below)
Name*
Address*
City, State, Zip*
Day Phone* ( ) -
Home Phone* ( ) -
Email
Your Age* (18-30)
(31-45)
(46-64)
(65+)
Have you contacted the business/person about your complaint?* Yes
No
Have you contacted an Attorney about your complaint?* Yes
No
Complaint Reported Against:
(their name and address goes below)
Name of firm or person complained of*
Address
City, State, Zip
Phone ( ) -
Name of individual with whom you dealt
Complaint Information:
Your Address at Date of Purchase
(if different than above)
City, State, Zip
Date of Purchase of Product
Method of Payment
Type of Product or Service*
Cost of Product or Service
Actual Amount Paid
Describe the facts which have led to the complaint and be sure to include if possible, the exact dates of important events.
 
Please describe what resolution you are seeking for this complaint.
 
You may send PHOTOCOPIES of any documents that may relate to your complaint (contracts, advertisements, correspondence, cancelled checks or other proofs of payment)

TO:
Consumer Protection Division
2115 State Capitol
Lincoln, Nebraska 68509-4906
Consumer Updates*
(place to check one or the other)
 Yes – please send me updates on consumer scams and frauds.
No – do not send me updates on consumer scams and frauds.
Disclaimer:
The information given above is true to the best of my knowledge and belief. I authorize the Nebraska Attorney General's Office to send this complaint form to the company or to the interested parties and to use the information given in any manner which is determined necessary. I understand that the Attorney General's Office is not my private attorney but represents the public in enforcing laws designed to protect consumers from misleading or unlawful business practices.
Agreement* I have read and agree with the disclaimer text

Note: Fields marked by an asterisk (*) are required.
This complaint may be forwarded to other law enforcement agencies.