Please enter the case number (if you have one)

If you were given a Case Number by one of our phone representatives please enter it here:

Online Consumer Complaint Form

To prevent delay, please answer all of the following questions. DO NOT include your Social Security Number on this form or any accompanying documents. At the end of this form, you may upload any signed contracts, written agreements, or other supporting documents related to this complaint.

= Required Information

1. Complainant Information

Are you with an agency or organization and filing on behalf of another individual?	(loading...)

Salutation
First Name
Middle Name
LastName
Suffix
Address
City
State
ZipCode

Age
Phone (area code required)
Are you or your spouse active duty military?
Email

2. Who is your complaint against?

Name/Firm
Address
City
State

Zip
Phone (area code required)
Person you dealt with
Email (optional)

3. The date(s) on which you entered into this transaction:

Transaction Dates

6. Do you consent to the Consumer Protection Division disclosing the following information to the public? (answers are required)

7. What was this transaction for?

My business

My family/household

My farm

Non-Profit/Church

9. Have you complained to the business?

Yes

If yes, when

Was any action taken?

10. Have you already filed a complaint with another agency?

If yes, who?
When?
What action has that agency taken?

11. Have you contacted a private attorney?

Yes

12. Have you started court action?

Yes

13. Have you been sued over this issue?

Yes

14. Did you sign a written agreement of contract? If Yes, please attach a copy of the documentation

Yes

15. Vehicle Identification Number (VIN)

The VIN is a 17 digit combination of letters and numbers that can be found on your purchase documents, vehicle registration, on the lower driver side quadrant of the windshield, or inside the door of the vehicle

16. Dollar amount associated with your loss, if any.

17. Please describe complaint in detail?

(2000 character limit)

You have 2000 characters left.

18. How would you like complaint resolved?

(400 character limit)

You have 400 characters left.

19. What will happen now? What else should you do?

The Consumer Protection Division will send a copy of your complaint to the respondent firm or licensed professional.

This office cannot disclose your complaint against a licensed professional to the public unless this office files a disciplinary action against the licensed professional. This office cannot disclose your complaint against any other person or firm without your consent.

This office represents the State of Indiana and is strictly limited in what remedies it can pursue. You may be entitled to compensation or other rights that we cannot pursue for you. In addition to filing this complaint, you should contact a private attorney or a small claims court.

20. Consent and Verification

I affirm, under the penalties for perjury, that the foregoing representations are true. I consent to the Consumer Protection Division obtaining or releasing any information in furtherance of the disposition of this complaint. I consent to the release of information included in this complaint to other public agencies attempting to discover ongoing fraudulent patterns or practices and for the purpose of law enforcement. I understand that I should not include my Social Security Number in any information submitted to the Consumer Protection Division. If I do provide my Social Security Number, I expressly consent to the disclosure of my Social Security Number in accordance with Indiana Code § 4-1-10-5(2).
Your Name
Date	[ 4/18/2024 ]

21. Consent to correspondence by Email

Do you consent to the Consumer Protection Division sending youcorrespondence related to this complaint to your email address? If yes, you will not bemailed such correspondence via the U.S. Postal Service. If you select Yes please enterthe email address we should use to send correspondence even if it is the same as theemail address you entered earlier.
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If you have supporting documentation or materials related to this complaint that you would like to upload at this time, please check the box below. After you click the Submit button below you will be directed to another page where you can upload those files.

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