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Consumer Protection

Complaint Form - Consumer Protection Division

CONSUMER COMPLAINT FORM

WHAT WE DO:

The Consumer Protection Division investigates and responds to complaints concerning both tenant/landlord and consumer problems. Complaints are resolved through mediation or arbitration between the parties and through law enforcement procedures, where appropriate. We can assist you if your dispute involves a business or tenant/landlord transaction that occurred in Fairfax County.

WHAT WE DO NOT DO:

We do not provide legal advice or regulate prices or rents. We do not handle employee vs. employer disputes or discrimination disputes. We do not handle business vs. business disputes. We do not handle cases against government agencies.

IF YOU HAVE A COMPLAINT:

Please be sure you have made an effort to resolve the matter by dealing directly with the manager or owner of the company or landlord involved. If you have exhausted all efforts to resolve the complaint yourself, complete this form, and electronically submit it to this Division. Your supporting documentation such as leases, contracts, repair invoices, and advertisements must be received within five (5) business days of your complaint submission either by mail or fax; otherwise, your complaint will not be processed. Upon receipt of the complaint form and documentation, we will let you know who is handling your complaint, initiate an investigation, and notify you of our findings as soon as possible. If you have any questions, please contact the investigator assigned to your case for assistance.

As an option, you may print this form, complete the information, and fax or mail the form with your supporting documentation to this Division.

NOTE: Items with a "*" are required.

PLEASE COMPLETE THE FOLLOWING INFORMATION ON THE COMPLAINT FORM:

*Please Enter Your Name

Prefix	First	Middle	Last	Suffix

*Address

*City

*State/Province *Zip -

Country

*Phone

Business:	- - ext.
Home:	- - ext.

Fax

- -

Email

Please enter only one email address:

Survey

*Please enter the NAME, ADDRESS, and PHONE NUMBER of the business about which you are complaining (the RESPONDENT):

Enter the DATE OF TRANSACTION:

(MM/DD/YYYY)

*Have you CONTACTED THE RESPONDENT about this complaint?

Yes
No

If Yes, what was the OUTCOME?

Do you have a SIGNED CONTRACT or LEASE?

If Yes, what is the EXPIRATION DATE on the contract?

(MM/DD/YYYY)

*What RESOLUTION would you consider to be mutually fair?

What is the DOLLAR AMOUNT of the dispute (if any)?

What other AGENCIES/ORGANIZATIONS have you contacted for assistance?

*Please provide a description of the complaint: (Please restrict your description to 2000 characters.)

DISCLOSURE STATEMENT:

All information provided to the Consumer Protection Division is available for inspection by the public under the Virginia Freedom of Information Act, except those cases which may be referred to law enforcement agencies.

The information requested by this Division is subject to the Virginia Privacy Act of 1976. Accordingly, you are not required to provide any of the requested information. The Consumer Protection Division, however, is less likely to be able to assist you if you do not provide the requested information.

I hereby certify that the statements made on this form and in my documents are true and complete to the best of my knowledge, information, and belief.

TYPING YOUR NAME AND ELECTRONICALLY SENDING THIS FORM TO THE CONSUMER PROTECTION DIVISION CONSTITUTES YOUR ELECTRONIC SIGNATURE.

*Signature

(MM/DD/YYYY)
Date

Prior to submitting this complaint, please print this page for your records.

Yes, I acknowledge my documentation must be received within 5 business days at the following address:

Online Complaints
Consumer Protection Division
12000 Government Center Pkwy., Suite 433
Fairfax, VA 22035-0047
MAIN: 703-222-8435
TTY: 711 (Virginia Relay)
FAX: 703-324-3900

No, I do not have further documentation to submit.

IF YOU HAVE READ THE ABOVE DISCLOSURE STATEMENT AND ENTERED ALL RELEVANT INFORMATION, CLICK ON "SUBMIT FORM" (ONLY ONCE) TO SUBMIT YOUR COMPLAINT.