The State of South Carolina
SOUTH CAROLINA DEPARTMENT OF CONSUMER AFFAIRS
CONSUMER COMPLAINT FORM
General Instructions
This is a form fill-in document. You can use your TAB key to move from field to field. A red * means a required field. Most are required. We aim to help you as quickly as possible so please be as precise as you can. The pull-down menus have been populated with the most frequent responses. Click on the"arrow" and a list of choices will appear. If the space is blank, you will need to type in your response. We have purposely set this up to NOT time out in order to give you as much time as you need to collect the information. However, if you leave this page without clicking on the Submit button in the lower left hand corner, your responses will not be saved.
 
Your Information Business Information
Prefix*
First Name
Last Name*
Suffix
Address 1*
Address 2
City*
County
State*
Country*
Zip Code*
Contact Number*
 area code included
Work Phone
Email Address*
Age Group
Name of the Person you dealt with:
 Prefix
Suffix
Name of Business*
Business Address 1*
Business Address 2
Business City*
Business County
Business State*
Business Country*
Business Zip Code*
Business Contact Number
area code included
Business Email Address
Business Web Address
   
Have you contacted the business regarding your complaint.* Yes No
If yes, have you received a written reply from the business concerning your complaint.* Yes No
Have you filed a complaint with any other consumer protection agency.* Yes No
If yes, complete the following. Name of Agency*
        
.
Agency Contact Number*
  
Agency Address*
        
           
Have you filed a complaint with the Better Business Bureau.*
 Yes No
If yes, complete the following. Name of Bureau*
        
Bureau Contact Number*
  
Bureau Address*
        
         
Have you taken this matter to court or hired a lawyer to represent you.* Yes No
If yes, complete the following. Name of Lawyer or Firm*
        
Lawyer's Contact Number*
  
Lawyer's Address*
        
         
Please provide a complete explanation of your complaint.*
         
Do you have supporting documents.* Yes No
If you answered "yes" to the above question, you must submit two copies of each supporting document within five (5) weekdays after electronically filing your complaint. We may not be able to process your complaint until your supporting documents, if any, have been received.
         
What is a fair resolution to your complaint.*
   

A confirmation email will be sent to your email address. It will contain your responses given above. You can also PRINT the filled out complaint form. Please retain either copy for your records. Once you Reset (clear), or Submit (enter) or Leave this page, you will not be able to retrieve your information.

By submitting this form, you certify that the above statements are true and accurate to the best of your knowledge. This information will be forwarded to the business(es) involved.

NOTE: THE SOUTH CAROLINA FREEDOM OF INFORMATION ACT MAY REQUIRE THE DEPARTMENT OF CONSUMER AFFAIRS TO RELEASE A COPY OF YOUR COMPLAINT AS A MATTER OF PUBLIC RECORD.