- All fields with an ASTERISK(*) are required, but any additional information you can provide will enable us to better assist you.
- This form is for new submissions only. To follow up on a previously-submitted complaint, or for additional assistance with this form, please call our Helpline at (800)771-7755. For hearing impaired: TDD (800)788-9898.
- Generally, it is best to complain to the Company or Individual BEFORE filing.
We need your contact information if you are seeking assistance such as a refund or other relief. If you choose not to provide your contact information, we will not be able to contact you for more information or contact the subject of the complaint on your behalf. In either case, we may share your complaint with other state, local and federal agencies.