3. Name of the company with which you dealt:
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4. Name and title of company agents or employees with whom you dealt:
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5. Do you have any complaint-related contracts, bills, receipts, canceled checks, correspondence or any other documents you feel are related to your complaint?
Yes
No
If the answer to question 5 above is "Yes," you will be required to forward readable copies of any complaint-related contracts, bills, receipts, canceled checks, correspondence or any other documents relating to your complaint to the Division of Consumer Affairs, Office of Consumer Protection, 124 Halsey Street, PO Box 45025, Newark, N.J. 07101. The Division will not initiate an investigation of your complaint until it has received legible copies of all of the documents you intend to submit as part of the evidence to support your complaint. Due to the fact that your name will be used as your case identifier, please be sure to write your name in the upper left-hand corner of every document that you submit to the Division of Consumer Affairs. Reminder: Retain the original document(s) and send only photostats of these papers. |
6. Describe the facts of your complaint in the order in which they happened.
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7. The amount of loss involved in this complaint: |
