Please complete the form below with your information and the information for the business you are filing the complaint against. If you have any questions about this form, please call our hotline at (800) 649-2424 or (802) 656-3183, or e-mail us at AGO.CAP@vermont.gov.

If you do not receive any response from our office within 5 business days, please call or e-mail us to verify that we received your complaint.

COMPLAINTS ARE PUBLIC RECORD, AND ALL DOCUMENTS YOU SEND US WILL BE SAVED ELECTRONICALLY.

DO NOT SEND MATERIALS CONTAINING SOCIAL SECURITY NUMBERS, ACCOUNT NUMBERS OR OTHER SENSITIVE INFORMATION WITH YOUR COMPLAINT UNLESS YOU FIRST REMOVE OR MARK OVER THE INFORMATION.

*6/6/2017 - Currently, our file attachment feature is not working properly. Please send us any additional documents by e-mail to AGO.CAP@vermont.gov, or by fax to 802-304-1014.

Your Contact Information

Your First Name *

Your Last Name *

Your E-Mail Address

Your Daytime Phone

Your Age Optional.

I am a... Please select all that apply to you.

Senior
Business
Veteran
Active Military
Student
Vulnerable Adult
Fuel Assistance Recipient

What is the name of your business?

Your Mailing Address *

Your City *

Your Zip Code *

Your Alternate Phone

Contact Information for Business the Complaint is Against:

Business Name or Person's First Name *

Person's Last Name

Business Phone (1)

Business Phone (2)

Business E-Mail Address Please include if possible, as this will speed processing of your complaint

Business Address *

Business City *

Business Zip Code *

Business Website/URL

Please Describe Your Complaint

Description *

Amount of loss:

How would you like this matter to be resolved?

Additional Complaint Information

Incident Date When did this incident occur? (If unknown, enter today's date)

Attachment Please attach any additional documentation you want to include. All files may be public record, so please delete any personal account numbers (such as your Social Security or bank account number)

Attorney General's Consumer Assistance Program | 109 State Street Montpelier, VT 05609-1001 | Hotline: Toll-free in VT 800-649-2424; (802) 656-3183 | FAX (802) 304-1014