Please fill out the form below to file your complaint with our office. Be aware that this complaint and the information you provide are records open to the public under Texas Law. There are several required fields which must be filled out for your form to be accepted. Of particular note, if the business you're complaining against is in Texas, please select the county in which it is located.

Once you submit the form, you will be able to review and edit your form, as well as electronically upload any supporting documents you may have. Please have the documents prepared before you fill out this form. Documents may not be larger than 16 MB, and must be one of the following file types: BMP, DOC, GIF, HTML, JPG, PDF, PNG, TIFF, TXT, WPD or XLS. If you have any other type you wish to submit, you may either copy and paste the data to a supported text file type, or scan the document and submit it as a supported type.

This complaint and the information you provide are records open to the public under Texas Law.

Consumer's (Your) Information
* = Required
First Name: *
Middle Name:
Last Name: *
Doing Business As:
Address 1: *
Address 2:
State: *
County: *
Home Phone: -- Ext:
Work Phone: -- Ext:
Supporting Documents will be sent by: (You may also upload attachments once this form has been submitted.)
Age: 19 or under
65 or over

Business or Individual the Complaint is Filed Against
Name of business:*
Business Address 1:*
Business Address 2:
Business City:*
Business State: *
Business Zip:
Business County: *
Business Phone: -- Ext:
Name of person you dealt with:
E-mail Address:

Contact with Business
First contact with the business:
If other, please specify:
If you responded to a solicitation in another language, which?
Where did the transaction take place?
If other, please specify:
Transaction Date [clear]:
Did you sign a contract?
Yes No
How much did the company/individual originally ask you to pay?
(Dollar amounts only, e.g. 786.43, 2498.32, etc.)
How much did you actually pay?
(Dollar amounts only, e.g. 786.43, 2498.32, etc.)
Method of payment:
Date of payment [clear]:
Have you complained to the business:
If Yes, when?
What was the business' response?

Have you contacted another agency or attorney about this complaint?
If Yes, please list name and address of the agency or attorney?
What action was taken by this agency or attorney?

Please describe your complaint in detail: *

Revised: March 17, 2014