OFFICE HOURS MONDAY – FRIDAY 9 AM – 3 PM PLEASE READ ALL SHEETS CAREFULLY Enclosed is the Complaint Form you requested. Consumer Assistance Council (CAC), is a non-profit volunteer organization that serves to educate & assist consumers in trying to resolve complaints with merchants. An experienced volunteer mediator will mediate your complaint through an informal process in an effort to reach a mutually agreeable settlement . CAC is NOT A LEGAL ASSISTANCE AGENCY & CAN NOT PROVIDE LEGAL ADVICE OR REPRESENTATION. WE DO NOT HAVE ENFORCEMENT POWERS. COMPLAINT PROCESS- HOW WE WORK When your completed Complaint Form is received, it will be assigned to a volunteer mediator who will handle your complaint. A letter will be sent to the business requesting that they respond within 14 days. If a reply is not received, the volunteer mediator will attempt additional follow up. You will receive a letter from us indicating your CASE NUMBER, (please keep this case number for future reference when you contact the office) and noting the name of your volunteer mediator and the day he/she volunteers, should you need to speak with them. Please keep your Volunteer Mediator informed of any new developments in your case. Please note that the names of all parties are submitted to the Attorney General's Office so that agency may effectively monitor any emerging patterns relative to your complaint. The Attorney General may then be in a position to intervene in those cases that affect a larger segment of the population. If you h ave questions concerning the specific application or interpretation of the law, you should consult a private attorney. If you do not have an attorney, you can call the following Bar Association for your area: BARNSTABLE COUNTY 3217 Main Street PO Box 586 Barnstable, MA 02630 BRISTOL COUNTY 448 County Street New Bedford, MA 02740-5399 If you cannot afford an attorney you may be eligible for assistance through your local Legal Services Office. Thank you for bringing this matter to our attention. We hope we can provide assistance to you. Kimberly Denis Executive Director 149 MAIN STREET HYANNIS, MA 02601 E-MAIL: [email protected] www.consumercouncil.com TELEPHONE: 508-771-0700 FAX: 508-771-3011 800-867-0701 CONSUMER COMPLAINT FORM - fill out on your PC CONSUMER CONSUMER: Please supply information requested below. TYPE info. -then print. Name: __________________________________________________ Address: ________________________________________________ City/State/Zip: ___________________________________________ Tel: Home ( ___ )____________________ Work: (___ )_________________ BUSINESS/Complaint Against COMPLAINT IS AGAINST: Please supply information requested below: Name: _________________________________________________ Address: _______________________________________________ City/State/Zip:___________________________________________ Tel: (____)___________________Fax: (_____)____________________ Product/Service involved: __________________________________________________________________ Person dealt with: ___________________________Place of Transaction: ____________________________ Date purchased: ___________________ Was deposit paid? Yes / No Amount $ _______________________ Method of Payment: Cash_________ Loan__________ Credit Card __________Other ________________ Contract Signed: Yes / No Name of Witness(s): ______________________________________________ How did you complain? By Phone __________ By Letter _________ In Person _______________________ To Whom: ______________________________________________________________________________ When: __________________________________________________________________________________ IF AUTO COMPLAINT: MAKE/MODEL: _____________________________________________________________________ VEHICLE I.D.# (on title registration): _________________ NEW / USED PURCHASE / LEASE Odometer reading (at purchase): _______________________ Current mileage: ___________________ Purchase price: $ ___________________ Payments: $______________________________________ Total number of times vehicle has been repaired for the same problem or defect: ___________________ Total number of business days (Monday – Friday) vehicle has been in repair shop: _________________ Have you contacted another agency? ________________ Have you hired an attorney? ______________ If yes, please give the name of the agency below. If yes, please give the name of the Attorney below. Please sign the complaint form after briefly describing your consumer complaints. Try to explain your problem in chronological order, using dates, if possible. When you return the completed form, please enclose clear copies (keep original copies) of any bills, receipts, contracts, and advertisements, repair orders or any other relevant documents. State here what action, if any, you have taken to resolve this problem and what you would like as a remedy. (Please print or type.) May we send a copy of your complaint to the merchant? Yes ____________ No ______________ Signature: ____________________________________Date: ______________________________ CONFIDENTIALITY Under most circumstances, the text of your complaint will be considered a public record, a copy of which is available to any member of the public upon request. However, your name, address, phone number, and any other information that identifies you will not be disclosed. Furthermore, no part of your complaint will be disclosed in response to a request that asks specifically for a complaint submitted by you.
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