The mediation staff, which includes volunteers, is available to assist consumers in resolving their disputes with business entities by offering to mediate those disputes.  The mediation staff also provides information about consumer transactions by answering questions from the public and by educating consumers and businesses as to their rights and responsibilities.  The online consumer protection complaint form can be printed, filled out and mailed to us (see attachment at bottom of the page).  Or you may call (408) 792-2880 or e-mail us and we will mail you a complaint form.


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RETURN TO:
Office of the District Attorney
Consumer Protection Unit
County Government Center, West Wing
70 West Hedding Street
San Jose, CA 95110
Telephone: (408) 792-2880
Fax: (408) 279-8742
CONSUMER COMPLAINT FORM
CONSUMER PROTECTION UNIT
Please complete complaint form as follows and return COMPLAINT NO. ______
to the above address.
1. Type or print clearly in dark ink.
2. Return TWO COPIES of the complaint form and all supporting documents.
3. Write the correct ADDRESS and TELEPHONE NO. of the business, SIGN and DATE
your complaint.
CONSUMER:
Your Name:_____________________________________________________________________
Day Telephone:__________________________ Night Telephone:_____________________
Street Address:________________________________________________________________
City/Town:___________________________________ State:________ Zip:____________
COMPLAINT:
Name of Business/Individual about which you are complaining:
____________________________________________________________________________
Street Address:________________________________________________________________
City/Town:___________________________ State:______ Zip:_______ Telephone:_________
Date/City of Transaction: Amount of Loss How Paid?
_________________________$_____________ [ ]Cash [ ]Check [ ]Credit Card
Did you sign a contract? Date
[ ]Yes [ ]No Where? __________________________________________
Was product or service advertised? Date: ________________________
[ ]Yes [ ]No Where? ____________________________________ _________
Have you complained to the company or the individual? Date
[ ]Yes [ ]No How? [ ]By Mail [ ]By Telephone [ ]In Person _________
Person Contacted and Job Title
________________________________________________________________________
How did the business/individual respond? Date of Response
__________________________________________________________________________
Has matter been submitted to another agency? If yes, give name
[ ]Yes [ ]No_______________________
Have you contacted a private attorney? If yes, give name: Is court action pending?
[ ]Yes [ ]NO __________________ [ ]Yes [ ]No
What form of relief are you seeking? (e.g. exchange, repair, money back, etc.)
_____________________________________________________________________________
TYPE OF COMPLAINT - e.g. car, mail order, etc.
_____________________________________________________________________________
SUMMARY OF COMPLAINT: (Attach extra sheets if necessary.)
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
PLEASE READ THE FOLLOWING BEFORE SIGNING BELOW:
COMPLAINT - MEDIATION PROCESS:
A. Written complaint is sent to Mediation/Intake Unit for review by Director.
B. Complaint is assigned to Mediation Specialist - a volunteer or staff member
who is skilled and trained to assist both parties in finding a mutually
acceptable solution.
C. The business is sent a copy of the complaint or is contacted by telephone.
D. The Consumer Protection Unit represents the public. Therefore the mediator
is not an advocate for either party nor does he/she make any decision as
to the facts.
E. Mediation is concluded when an agreement is reached or when either party
refuses to participate any further.
F. A complaint that indicates that a business may have engaged in unlawful,
unfair, or fraudulent business practice, or conducted deceptive
advertising, will be reviewed by a deputy district attorney for further
action.
The above complaint is true and accurate to the best of my knowledge.
Signature:_______________________________________Date:________________
HAVE YOU ENCLOSED TWO COPIES OF IMPORTANT PAPERS?