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On-Line DCA Complaint Form

Be sure to read the agency referral list before submitting a complaint.

Download and print the Consumer Complaint Form in English or Spanish (in PDF). Use this form for complaints against a Home Improvement Contractor.

If you have a complaint about a phone card, use this special form in English and Spanish (in PDF).

If you have a complaint about the sale of illegal toy guns, complete DCA’s Toy Gun Sales Complaint Form

* Required fields must be completed before submitting complaint.

Please tell us about yourself
* First Name:   * Last Name:
* Address: * City:
* State: Country:
* ZIP Code: * E-mail:
Phone Number
(night):
Phone Number
(day):
 
Please put me on Consumer Affairs' e-mail list for Press Release updates
 
Please tell us your complaint
* Vendor's Name:   * Vendor's Address:
* City: State:
* ZIP Code: Phone Number:
Fax Number: DCA License
Number:
 
Please complete the following
  1. * Have you contacted the vendor? Yes No
    How many times?

  2. Contact's Name:
    Date of Contact:

  3. * Product or service in dispute:

  4. Date of purchase:
    Total purchase price: $

  5. * Written contract? Yes No (Please see Important Note below.)

  6. Down payment: $
    * Layaway? Yes No (Please see Important Note below.)

  7. Payment made by Cash Check Credit Card
    Contacted credit card company? Yes No

  8. Is there a warranty? Yes No (Please see Important Note below.)

  9. * Have you filed your complaint with another agency? Yes No
    Name of agency:
    Contact's Name:

  10. * Has this matter been decided by Small Claims, Civil or Supreme Court?
    Yes No
    (Please see Important Note below.)
    Judgment for $ Dated:

  11. What action are you seeking from this agency to resolve this complaint?
    Repair of product or service? Exchange?
    Completion of terms of contract? Refund?
 
Please describe complaint

* Briefly and factually state the matter in contention below.


IMPORTANT NOTE

We will review your complaint to make sure that we are the correct agency to assist you.

If you are sending us your complaint online, please do not mail or fax another copy of your complaint. We will contact you to follow up.

So that we can help you, we'll need you to send us copies of documents about your complaint. These documents include: bill of sale, store receipts, warranties, contracts, cancelled checks, letters to the vendor, judgments, etc. Please be sure to have copies of these documents ready to send to us. Keep originals for your files.


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