Complaint Form

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Consumer Protection

Complaint Form

The Ministry of Government Services attempts to resolve disputes between consumers and businesses. It is important that you contact the business before sending us your complaint as your concerns will not be addressed until you have first approached the business directly.

Please complete questions one to 12 on this form
1	Consumer Mailing Address Last Name (Required) First Name (Required) Address (Required) Unit/Suite City/Town Province/State Postal/Zip Code Country
2	Consumer Contact Information Work Telephone Number Home Telephone Number Fax Number E-mail Address
3	Complaint Against Business Name Contact Name Contact Title Address Unit/Suite City/Town Province/State Postal/Zip Code Country Telephone Number Fax Number E-mail Address If your complaint is against a collection agency or bailiff, please name the collector or bailiff and specify the issue you have with this person.
4	Description of goods or services
5	Date of supply of goods or services
6	Value of goods or services $
7	Method of payment for goods or services Cash Cheque Debit Card Credit Card Money Order N/A
8	How was your contract formed? By: Mail Door-to-door Over the counter E-commerce Telephone N/A
9	Briefly describe your concerns about the business.
10	What do you want the business to do to resolve your complaint?
11	Where did you hear about us? (Required) (please do not disclose personal names)
12	Important Notice The personal information gathered on this form, and in any subsequent submissions you make is collected in compliance with section 38(2) of the Freedom of Information and Protection of Personal Privacy Act, R.S.O. 1990 F.31 and the Consumer Protection Act 2002, S.O. 2002 Chap.30, Schedule A, as amended. You will not be placed on any mailing lists. Any personal information you give us will only be used for the purposes of complaint mediation and/or investigation of the business practices of the business. By submitting this form you declare the information you provide to be true and correct. You are also consenting to the sharing of the information you submit, to the business in question, any government ministry (federal or provincial), agency, board or commission, any self-regulatory body or association and any law enforcement agency. I Agree (Required)

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Last Modified: 2006-08-22