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Consumer Complaint Form

This form is also available in PDF format. Click here to download it and mail the completed
form to:

Consumer Complaint Division
Attorney Generals Office
2115 State Capitol, Lincoln, NE 68509

(Consumer Complaint Form En EspaƱol)

Complaint Reported By:

(Enter your name and address below)

Name
First
Last
Address
County
Day Phone
Home Phone
Your Age
 
 
 
 
 
 
 
Military (If Applicable)
 
 
Preferred Method of Correspondence
 
Have you contacted the business/person about your complaint?
 
 
Have you contacted an Attorney about your complaint?
 
 

Complaint Reported Against

(Enter their name and address below)

Name of the firm or person complained of
Address
Phone
Name of individual with whom you dealt

Complaint Information

Your Address at Date of Purchase (if different than above)
Date of Purchase of Product
Method of Payment
Type of Product of 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 Complaint Division
2115 State Capitol
Lincoln, Nebraska 68509-4906

Options
 

Check if you would like us to respond to you directly.

 

Check if this referral is just to give us information and you do not need us to respond to you directly.

 

Check if you will be mailing documentation along with this complaint.

Documents can be mailed to:
Consumer Complaint Division
Attorney Generals Office
2115 State Capitol, Lincoln, NE 68509.

*Consumer Updates
(please select one or the other)

Consumer Updates
 
 

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
 
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