{"id":2667,"date":"2019-09-19T10:08:24","date_gmt":"2019-09-19T00:08:24","guid":{"rendered":"https:\/\/www.cnmioag.org\/?page_id=2667"},"modified":"2025-12-02T14:05:29","modified_gmt":"2025-12-02T04:05:29","slug":"complaint-form","status":"publish","type":"page","link":"https:\/\/www.cnmioag.org\/divisions\/consumer-protection\/complaint-form\/","title":{"rendered":"Complaint Form"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f2665-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"2665\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/wp-json\/wp\/v2\/pages\/2667#wpcf7-f2665-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"2665\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f2665-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<p>Section 1. Your Information\n<\/p>\n<div class=\"clearfix\">\n\t<div id=\"left\">\n\t\t<p>Name:<span class=\"wpcf7-form-control-wrap\" data-name=\"Complainant-Name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Complainant-Name\" \/><\/span>\n\t\t<\/p>\n\t\t<p>Address: <span class=\"wpcf7-form-control-wrap\" data-name=\"Complainant-Address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Complainant-Address\" \/><\/span>\n\t\t<\/p>\n\t\t<p>City: <span class=\"wpcf7-form-control-wrap\" data-name=\"Complainant-City\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Complainant-City\" \/><\/span>\n\t\t<\/p>\n\t\t<p>State: <span class=\"wpcf7-form-control-wrap\" data-name=\"Complainant-State\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Complainant-State\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"right\">\n\t\t<p>ZIP Code: <span class=\"wpcf7-form-control-wrap\" data-name=\"Complainant-ZipCode\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Complainant-ZipCode\" \/><\/span>\n\t\t<\/p>\n\t\t<p>Email Address: <span class=\"wpcf7-form-control-wrap\" data-name=\"email-Complainant\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email-Complainant\" \/><\/span>\n\t\t<\/p>\n\t\t<p>Phone Number: <span class=\"wpcf7-form-control-wrap\" data-name=\"Complainant-Phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" placeholder=\"Include area code\" value=\"\" type=\"tel\" name=\"Complainant-Phone\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p>_____________________________________________________________________________\n<\/p>\n<p>Section 2. Name of Company or Individual about which or whom you are complaining\n<\/p>\n<div class=\"clearfix\">\n\t<div id=\"left\">\n\t\t<p>Company\/Business Name: <span class=\"wpcf7-form-control-wrap\" data-name=\"Business-Name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Business-Name\" \/><\/span>\n\t\t<\/p>\n\t\t<p>Address: <span class=\"wpcf7-form-control-wrap\" data-name=\"Business-Address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Business-Address\" \/><\/span>\n\t\t<\/p>\n\t\t<p>City: <span class=\"wpcf7-form-control-wrap\" data-name=\"Business-City\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Business-City\" \/><\/span>\n\t\t<\/p>\n\t\t<p>State: <span class=\"wpcf7-form-control-wrap\" data-name=\"Business-State\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Business-State\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"right\">\n\t\t<p>ZIP Code: <span class=\"wpcf7-form-control-wrap\" data-name=\"Business-ZipCode\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Business-ZipCode\" \/><\/span>\n\t\t<\/p>\n\t\t<p>Phone Number: <span class=\"wpcf7-form-control-wrap\" data-name=\"Business-Phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" placeholder=\"Include area code\" value=\"\" type=\"tel\" name=\"Business-Phone\" \/><\/span>\n\t\t<\/p>\n\t\t<p>Website: <span class=\"wpcf7-form-control-wrap\" data-name=\"url-business\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-url wpcf7-text wpcf7-validates-as-url\" aria-invalid=\"false\" value=\"\" type=\"url\" name=\"url-business\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p>_____________________________________________________________________________\n<\/p>\n<p>Section 3. Complaint Information\n<\/p>\n<div class=\"clearfix\">\n\t<div id=\"left\">\n\t\t<p>Type of product, item, or service involved: <span class=\"wpcf7-form-control-wrap\" data-name=\"complaint-type\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"complaint-type\" \/><\/span>\n\t\t<\/p>\n\t\t<p>Date of purchase\/service\/contract:<span class=\"wpcf7-form-control-wrap\" data-name=\"date-of-contract\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-of-contract\" \/><\/span>\n\t\t<\/p>\n\t\t<p>Did you sign a contract or lease?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"contract-or-lease\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"contract-or-lease\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"contract-or-lease\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p>If Yes, indicate<br \/>\n---Start date:<span class=\"wpcf7-form-control-wrap\" data-name=\"date-start-of-agreement\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-start-of-agreement\" \/><\/span><br \/>\n---Expiration date: <span class=\"wpcf7-form-control-wrap\" data-name=\"date-end-of-agreement\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-end-of-agreement\" \/><\/span>\n\t\t<\/p>\n\t\t<p>Total amount paid: <span class=\"wpcf7-form-control-wrap\" data-name=\"complaint-amount\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"complaint-amount\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"right\">\n\t\t<p>How was payment made:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-payment-method\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" multiple=\"multiple\" name=\"menu-payment-method[]\"><option value=\"Cash\">Cash<\/option><option value=\"Check\">Check<\/option><option value=\"Credit card\">Credit card<\/option><option value=\"Money order\">Money order<\/option><option value=\"Other\">Other<\/option><\/select><\/span>\n\t\t<\/p>\n\t\t<p>Did you receive a receipt for your purchase? <span class=\"wpcf7-form-control-wrap\" data-name=\"receive-receipt\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"receive-receipt\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"receive-receipt\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p>How was the transaction initiated?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-transaction-via\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" multiple=\"multiple\" name=\"menu-transaction-via[]\"><option value=\"Business contacted me\">Business contacted me<\/option><option value=\"Flyer\">Flyer<\/option><option value=\"Radio\/television\">Radio\/television<\/option><option value=\"Self initiated\">Self initiated<\/option><option value=\"Other\">Other<\/option><\/select><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p>_____________________________________________________________________________\n<\/p>\n<p>Section 4. Detailed description of Complaint<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"complaint-details\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"complaint-details\"><\/textarea><\/span><br \/>\n_____________________________________________________________________________\n<\/p>\n<p>Section 5. Resolution attempts you have made\n<\/p>\n<div class=\"clearfix\">\n\t<div id=\"left\">\n\t\t<p>Have you contacted the company or individual?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"attempt-to-contact\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"attempt-to-contact\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"attempt-to-contact\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p>If Yes, name of the person most recently contacted: <span class=\"wpcf7-form-control-wrap\" data-name=\"person-contacted\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"person-contacted\" \/><\/span>\n\t\t<\/p>\n\t\t<p>Phone number: <span class=\"wpcf7-form-control-wrap\" data-name=\"person-contacted-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"person-contacted-phone\" \/><\/span>\n\t\t<\/p>\n\t\t<p>Email address: <span class=\"wpcf7-form-control-wrap\" data-name=\"person-contacted-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"person-contacted-email\" \/><\/span>\n\t\t<\/p>\n\t\t<p>Results of your resolution attempt:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"resolution-result\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"resolution-result\"><\/textarea><\/span>\n\t\t<\/p>\n\t\t<p>If necessary, would you be willing to testify in court? <span class=\"wpcf7-form-control-wrap\" data-name=\"willing-to-testify\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"willing-to-testify\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"right\">\n\t\t<p>Have you contacted any other agency or individual regarding this complaint? <span class=\"wpcf7-form-control-wrap\" data-name=\"contacted-other-agency\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"If Yes, please state name or agency or individual\" name=\"contacted-other-agency\"><\/textarea><\/span>\n\t\t<\/p>\n\t\t<p>What resolution would you consider mutually fair? <span class=\"wpcf7-form-control-wrap\" data-name=\"fair-resolution\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"fair-resolution\"><\/textarea><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p>_____________________________________________________________________________\n<\/p>\n<p>Section 6. Disclaimers and Affidavits\n<\/p>\n<p>By clicking \"SUBMIT\" below, you:\n<\/p>\n<p>\u2022 authorize the Office of the Attorney General and any other local, state or federal agencies with which we may work on this matter, to evaluate your complaint, to contact you, and to take whatever lawful actions are deemed appropriate with regard to your complaint.\n<\/p>\n<p>\u2022 certify that the statements made herein or on any attached documentation are true and complete to the best of your knowledge, information and belief.\n<\/p>\n<p>\u2022 acknowledge that this complaint will become part of the Office of the Attorney General\u2019s records and you authorize the release of information and documentation relative to this complaint.\n<\/p>\n<p>_____________________________________________________________________________\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"SUBMIT\" \/>\n<\/p><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"190\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":85,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"class_list":["post-2667","page","type-page","status-publish","hentry","post"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - 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