Montana Department of Justice · Consumer Protection

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Consumer Complaint Form

To submit your complaint:

Fill out this form as completely as possible, print and sign it, and mail the signed original (not a copy) to the Office of Consumer Protection. Keep a copy for your own records. Note: This form cannot be submitted online.
Office of Consumer Protection
2225 11th Avenue
P.O. Box 200151
Helena, MT 59620-0151

Phone: (800) 481-6896 or (406) 444-4500
E-mail: contactocp@mt.gov
Enclose photocopies of all documents relevant to your complaint, such as receipts, warranties, both sides of cancelled checks, contracts, etc. In this case, do not send originals.

Note: Since most of the fields have a limited number of characters, please limit your responses to the space provided (that is, what is visible on the form when it is printed). If you need more space to explain your complaint, you may attach additional sheets to this form.

Your Name:

Mailing Address:

City:    State:    Zip:

Telephone No.: Home:    Business:

Party Complained About:

Mailing Address:

City:    State:    Zip:

Telephone No.:    Manager or Salesperson:

Product or Service Involved:

Model No.:

Serial No. or Vehicle Identification No. (VIN):

Purchase Price of Product: $    Approximate Cost of Repair or Replacement: $

Date of Transaction:

Was a contract signed? Yes - please attach a copy   No

Was a warranty issued? Yes - please attach a copy   No

If your complaint relates to false advertising or deceptive trade practices, for the product or service advertised indicate: Date of Advertisement:
Placement of Advertisement:
(If possible, attach a copy of the advertisement.)

Financial Institute Involved, if any:

Referred by (private attorney or legal aid group, etc.):
Name:
Address:

Have you contacted the party you are complaining about? Yes    No

Have you retained a private attorney? Yes    No

Did a telemarketer contact you? Yes    No

Nature of Complaint: Fully explain your complaint, describing events in the order in which they occurred. Use additional pages if necessary.

Desired Relief: Would you like a refund, repair, replacement, etc.?

NOTE: If you believe you need legal advice, we suggest you contact a private attorney to handle your complaint.

I understand that:

the State has full discretion concerning its acceptance, investigation and resolution of this complaint;
the State cannot act as my attorney; and
no attorney/client relationship is established as a result of any activities undertaken on my behalf.

I hereby:

affirm that this complaint is true and correct to the best of my knowledge; and
authorize the use of my name and this complaint in investigating the company or individual complained of.

DATE: SIGNED:

Optional: Please answer the following questions. This information will help us determine whom we serve and will be used for statistical purposes only.

Your age? 18-30 31-40 41-50 51-60 Over 60

Are you disabled? Yes No

If you are a minority member, designate which:

Note: This form cannot be submitted online. It must be printed and mailed to the Office of Consumer Protection.

Web Form OCP-100 (8/07)