Report Form

    Fields with a * are required fields

    Step 1:
    Enter your Consumer Contact Information

    Consumers Name *

    Consumers Address Street *

    Consumers Address City *

    Consumers Address State *

    Consumer Zip Code: *

    Preferred Phone Number *

    Secondary Phone Number

    Your Email Address *

    Step 2: Enter the Retailer/Business Information

    If you are unsure of the required information below, please contact our office at 908-654-9840 Monday thru Friday between the hours 8a.m and 4p.m

    Business Name *

    Business Address Street *

    Business Location *

    If the retailer or business is located in a different location outside Union County, please specify their city, state and zip code:

    Business Phone *

    Step 3: Provide the Nature of Complaint

    After submitting this form, please send us all required supportive documents that support your claim. The confirmation page will include easy methods of sending the information to us.

    Date of Transaction *

    Amount of Money Involved *

    Did You Complain to the Company *

    If Yes, the Date You Complained

    Check the resolution you desire below *

    If other explain briefly below

    Have you referred this complaint to another agency? Please name: *
    Have you referred this complaint to an attorney *

    Name of retail person you complained to *

    Type a brief description of your complaint below *

    Step 4: Agreement to Terms

    By checking here

    I certify that the information and statements made by me are true. Further, I authorize the Union County Office of Consumer Affairs to share my information with the Retailer/business, and, with other interested parties for the purpose of investigation, mediation and/or bringing to resolution said complaint.

    Step 5: Send Copies of Supportive Documents

    After submitting your complaint with the Union County Office of Consumer Affairs it will be assigned to an Investigator who will contact you if we need additional information.

    Remember to send your copies of your supporting documents to the:

    Union County Consumer Affairs
    300 North Avenue East
    Westfield, NJ 07090

    If you have any questions please call us at 908-654-9840. You can also scan and email copies of your supportive documents to

    Step 6: Print & Submit

    Please click here to print for your own record and reference. After printing, click below to submit your claim.

    You must agree to the terms in Step 4 to submit