Consumer Complaint Form

Complete form in sufficient detail to fully explain your problem, giving names, addresses, cities, telephone numbers, dates, etc., involved. Please furnish details in the order that they happened. A copy of your complaint may be sent to the respondent. Kindly upload copies of all contracts, and/or other documents relative to your complaint.
Date*
Name of Company or Firm Complained About*
Company Address*
Street Address Address Line 2 City State ZIP Code
Company Phone*
Salesperson*
Date of Transaction*
Name of Product or Service Involved*
If Product of Service was Advertised:
When
Where
Was a Contract Signed?*
- Yes
- No
If you have a signed contract, upload here
Accepted file types: jpeg, jpg, gif, pdf, png.
Name and Number of Attorney Contacted, if Any
Check Causes of Complaint*
- Advertised item not available
- Defective merchandise or work
- Guarantee/contract not fulfilled
- Misrepresentation(advertised)
- Misrepresentation(oral)
- Adjustment not fulfilled
- Unsatisfactory service
- Other
What Adjustment do You Consider Fair?
Your Full Name*
First Last
Your Address*
Street Address Address Line 2 City State ZIP Code
Email*
Your Home Phone*
Your Business Phone
Write out your complaint below giving who, when, where, and how the event occurred. Attach copies of everything involved in the transaction.
Summary of Complaint*
Additional File 1
Accepted file types: jpeg, jpg, gif, pdf, png, doc, docx.
Additional File 2
Accepted file types: jpeg, jpg, gif, pdf, png, doc, docx.
Additional File 3
Accepted file types: jpeg, jpg, gif, pdf, png, doc, docx.

Assistant Prosecuting Attorney(s)

Adele Ice-King
Evan Dashe

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1 South Main Street
Mount Clemens, Michigan 48043

(586) 469-5350

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