Complaint Form

Use this form to request assistance from this Department. Attach COPIES of appropriate documentation (correspondence, invoices, contracts, and related information). This material is necessary in order to attempt resolution of your complaint.

You may also download this form.

Consumer Information

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Vendor Information

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Have you complained to any of the following?

Supporting documentation must be attached before complaint can be processed.

Submit documentation as a single pdf or jpg image

  • I understand that Erie County Division of Consumer Protection may send a copy of this form and any or all, of the enclosed information to the vendor or another agency for resolution.
  • I hereby certify that the information I have given is true and complete to the best of my knowledge.
  • I understand that Erie County Division of Consumer Protection complies with the Freedom of Information Law.
  • I Authorize the Erie County Division of Consumer Protection to act on my behalf in the mediation of this complaint.
  • I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.

    Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your form will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.