Consumer Complaint Form - Missouri Attorney General
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1
2Missouri Attorney General
ago.mo.gov
Consumer
Josh Hawley
Complaint Form
800-392-8222
If you would like to file a consumer complaint, please complete and mail this form to:
Missouri Attorney General Josh Hawley
•
Consumer Protection Unit
•
P.O. Box 899
•
Jefferson City, MO 65102
Information About Consumer
YOUR NAME
Last
First
Mi
ADDRESS
Street
State
City
Zip
County
E-MAIL
ARE YOU 60 OR OVER?
No
Yes
(
)
-
PRIMARY PHONE NO.
ARE YOU DISABLED?
Yes
No
(
-
SECONDARY PHONE NO.
)
ARE YOU A VETERAN?
Yes
No
Information About Complaint
BUSINESS NAME
2 0
$
/
/
AMOUNT PAID
DATE OF TRANSACTION/PURCHASE
MM / DD/ YYYY
BRIEFLY DESCRIBE YOUR COMPLAINT
You may attach a separate sheet of paper if you need more space.
ADDRESS
Street
City
State
Zip
County
(
-
BUSINESS PHONE NO.
)
Yes
No
FINANCIAL LOSS?
Yes
No
IS CONTRACT SIGNED?
(
)
-
BUSINESS FAX NO.
E-MAIL
WEBSITE
CONTACT NAME
CONTACT TITLE
Modified April 2017
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