Name of Company:

Name of Individual:

Name of Website:

Web Address:

Complaint: (Check the appropriate box or boxes, if more than one is applicable)

failed to deliver merchandise after payment made.
merchandise delivered late.
merchandise defective and vendor did not permit return or did not replace item.
failed to deliver service after payment made.
deceptive advertising or misrepresentation as to merchandise or service.
unsatisfactory services or not performed according to contract.
overbilled for merchandise or for service.
billed for merchandise or services not ordered.