Attorney General William Tong
e-Complaint Form
Office of the Attorney General
165 Capitol Avenue
Hartford, Connecticut 06106
Please provide as much information as possible as this will help us serve you more effectively.
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Your Information
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Dr.
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Email Address:
Proper format "john_doe@gmail.com"
Provide a vaild email address to receive a confirmation receipt.
I am a senior citizen (over 60)
Have you ever served in the U.S. Military?
Yes
No
If yes, do you authorize the Attorney General's Office to share your contact information and/or this complaint and any attached documents with the Connecticut Department of Veterans Affairs (DVA) ?
Yes
No
If yes, do you want to receive information from the DVA regarding potential eligibility for veterans benefits?
Yes
No
Who is your complaint against?
Name Of Business Entity Or Provider Of Services:
Salutation:
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Dr.
Honorable
Mr.
Mr. and Mrs.
Mrs.
Ms.
Other
Complainee First Name:
Complainee Last Name:
Street Address:
City/Town:
State:
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Phone Number:
Extension:
(Optional)
Email Address:
Proper format "john_doe@example.com"
Business Website:
Complaint Subject:
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Advertisement
Agriculture
Antitrust
Auto Related Complaints
Banking
Bankruptcy
Business and Job Opportunities
Cemeteries
Charities
Child Protection Issues
Child Support
Clothing, Textiles and Jewelry
Computer Hardware/Software
Condo Association
Correction
Credit
Credit Bureaus, Etc
Credit Cards
Credit Cards / Debit Cards
Debt Collection
Discrimination
DMV Issues
Education
Education/Higher Education
Elections Enforcement Comm.
Employment
Environmental
Ethics Commission
FOI Request
Foreign/Counterfeit Scams
Fraud-Whistle Blower
Fuel
Government Agencies
Governmental Officials
Grants
Health Care
Health Care Issues
Health Clubs
Health Services Fraud
Healthcare Advocacy
Home Repair/Improvement
Home Solicitation Sales
Housing
Identity Theft
Immigration
Impostor Scams
Indian Matters
Information Request
Insurance
Internet Auction
Internet Services
Investment Solicitations
Judicial
Landlord Tenant
Legislature
Licensing Boards
Magazines and Books
Miscellaneous Agency Wide
Mortgages
Multi-Level Marketing/Pyramids
Nonpayment Of Wages
Office Of Policy And Management
Office Supplies and Services
Prisoner
Prizes, Sweepstakes and Lotteries
Public Safety
Real Estate
Real Estate Issues
Robocalls
Sales
Secretary Of State
Shop-at-Home and Catalog Sales
Siting Council
Special Revenue
Social Media
State Collection Issues
Storm/Emergency Gouging
Student Loans
Tax Issues
Telemarketing
Telephone and Mobile Services
Television and Electronic Media
Tobacco
Torts
Towns/Municipality
Transportation
Travel/Vacations/Timeshare Issues
Treasurer
Unemployment Compensation
Utilities
Utility Regulation
Veterans
Wills, Estates, Trusts
Workers Comp
Describe Your Complaint
Date of transaction or incident:
(Example: 01/01/1990)
Briefly Describe your complaint: (Note: 1000 characters maximum)
Number of characters remaining:
Is your complaint about goods or services?
Yes
No
Is your complaint about Robocalls or Phone Fraud?
Yes
No
Robocalls or Phone Fraud
If you wish to submit audio recordings or voicemails, please email them to AG.ConsProt@ct.gov
Other supporting documents, such as robocall log forms, screenshots, or call transcripts can be attached in the Supporting Documents Upload Section of this complaint.
Date and Time of Call:
(Example: 01/01/1990 12:00 am)
Type of Call?
Recording
Live Caller
Calling Number: (Scammer's Number)
Dialed Number: (Your Number)
Number of Calls:
(Optional)
Did you make a payment?
Yes
No
If yes, how did you pay?:
-- Select --
Cash
Check
Credit Card
Debit Card
PayPal
Prepaid Card
Internet Money Transfer
Money/Wire Transfer
online payment services
Traveler's cheques
Other
Payment Amount:
(Do not include $ sign.)
Goods Or Services Details
Did you make a payment?
Yes
No
If yes, how did you pay?:
-- Select --
Cash
Check
Credit Card
Debit Card
PayPal
Prepaid Card
Internet Money Transfer
Money/Wire Transfer
online payment services
Traveler's cheques
Other
Cost of product or service:
(Do not include $ sign.)
Did you sign a contract?
Yes
No
If yes, where contract was signed:
Date signed:
(Example: 01/01/1990)
Was product or service advertised?
Yes
No
If yes, where was it advertised:
Date advertised:
(Example: 01/01/1990)
Action Taken By You:
Have you previously contacted the CT Attorney General Office or other State or Federal Agencies about this matter?
Yes
No
If yes, please list the most recent dates and names of previously contacted State or Federal Agencies.
Contact Date:
Name of State or Federal Agency:
Have you contacted a private attorney regarding this matter?
Yes
No
If yes, provide attorney Name:
Attorney Phone:
Attorney Email Address:
Is court action or other legal proceeding pending?
Yes
No
If yes, provide Docket no.:
Do you want to upload supporting documents?
Yes
No
Supporting Documents Upload ...
File upload instructions:
Total number of files you can upload is 3
Maximum file size limit is 2MB (2000 KB)
Upload document files of type .docx, .doc, .txt and .pdf
Upload image files of type .jpg, .jpeg, .tif, tiff, .png and .bmp
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All rules above must be applied for a successful upload. If one file fails, re-select all files again.
Please
do NOT
include financial account numbers, credit or debit card numbers, your social security number, etc.,
or other sensitive personal identifying information. We will contact you if we need any of this information.
If we need additional documents from you, we will:
Contact you directly
Tell you what documents we need, and
Arrange for you to provide it to us in a more secure manner.
Select the file(s) by clicking the button below.
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Declaration and Signature
In filing this complaint, I acknowledge that the Attorney General does not represent me individually, but represents the State of Connecticut in enforcing laws designed to protect the public from deceptive or unfair practices. I understand that all questions concerning my legal rights or responsibilities, should be directed to the private attorney of my choosing.
I acknowledge that information submitted to the Office of the Attorney General may be considered public information subject to disclosure under the
Connecticut Freedom Of Information Act, Connecticut General Statutes Section 1-200 et. seq.
I understand that the Attorney General’s Office may contact the person or business that is the subject of the complaint. I authorize the Attorney General’s Office to provide a copy of this completed form and any attached documents to all necessary parties including the person or business that is subject of the complaint.
Signed By:
By typing my full name above and checking this box, I certify that the above complaint is true and accurate to the best of my knowledge and that any documents attached are true and accurate copies of original, and I adopt this as my online signature.
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