1. Your Information

2. Who is your complaint against?

3. First Contact Between You and the Firm?

A person came to my home
I went to the firm’s place of business
I responded to a TV/radio ad
I received a telephone call from the firm
I telephoned the firm
I received information in the mail
I responded to an offer on the Internet
I received information by e-mail
I responded to a printed advertisement
Other:   

4. Where Did the Transaction Take Place?

  My home
  At the firm’s place of business
  Away from the firm’s place of business (work, convention, etc.)
  By telephone
  By mail
  By Internet/e-mail
  Other:

5.  State the date(s) on which you entered into this transaction:

6.  What was this transaction for?
My business
My family/household
My farm

7.  How did you pay?

8.  Did you sign a contract or written agreement?
Yes      No     If yes, you will need to attach a copy, so you should download a form and mail it instead of using this online form.

9.  Do you consent to the Consumer Protection Division disclosing to the public the following (answers required):

10.  Have you contacted the firm your complaint is against? 
      Yes    No   If yes, when?

11. What action was taken?

12.  With what other agency have you filed this complaint?

13.  What action was taken?

*17.  Please summarize your complaint: (1200 character limit)

*18.  How would you like your complaint resolved? (300 character limit)


What will happen now?  What else should you do?

The Consumer Protection Division will send a copy of your complaint to the respondent firm or licensed professional.  

This office cannot disclose your complaint against a licensed professional to the public unless this office files a disciplinary action against the licensed professional.  This office cannot disclose your complaint against any other person or firm without your consent.  

This office represents the State of Indiana and is strictly limited in what remedies it can pursue.  You may be entitled to compensation or other rights that we cannot pursue for you.  In addition to filing this complaint, you should contact a private attorney or a small claims court.

By clicking “Submit”, you affirm that the information on this form, under the penalties for perjury, that the foregoing representations, and those in all attachments, are true. The information I have provided in this complaint form is based upon my personal knowledge. I consent to the release of any information to the Consumer Protection Division relating to this complaint. I understand that I should not include my Social Security Number in any information submitted to the Consumer Protection Division. If I do provide my Social Security Number, I expressly consent to the disclosure of my Social Security Number in accordance with Indiana Code § 4-1-10-5(2).

(If you have any trouble with this form, please contact the webmaster. You may also print out and then fill out the complaint form and send it to the address provided within the form.)