NYC Department of Consumer
and Worker Protection
42 Broadway, 9th floor
New York, NY 10004
Call 311 (212-NEW-YORK)
nyc.gov/dcwp
File Your Complaint
Thank you for contacting the New York City Department of Consumer and Worker Protection (DCWP). Please complete
this form. Clearly print or type your answers to each question. If a question does not apply to you, please mark N/A or
Not Applicable. You must provide information marked with a star (*).
You can submit this form in one of the following ways:
• Email: [email protected]
• Fax: 212-487-4482 / 646-500-5914
• Mail to the address above.
Important: Please submit copies of supporting documents for your complaint (for example, web printouts, contracts,
warranties, bills, statements, cancelled checks, correspondence including email, etc.). Note: Protect sensitive information.
Do not submit documents with Social Security numbers, bank account numbers, etc.
About You
*I am submitting this complaint for: Myself Someone else
If you checked “Someone else,” complete additional table below.
*I want to remain anonymous: Yes No
*First Name
*Last Name
*Home Address (include Apartment Number)
*City, State, ZIP Code
Country
*Phone Number
*Email
*Preferred method of contact: (Select one.) Email Phone
Has anyone in your household ever served, or are they currently serving? Yes No
If you checked “Yes,” select any that apply.
Self
Other (explain):
U.S. Armed Services
National Guard
Reserves
If you are submitting this complaint form for someone else, you must provide information about the complainant. If you do not
provide complainant information, you cannot receive a response from the business.
First Name
Last Name
Home Address (include Apartment Number)
City, State, ZIP Code
Country
Phone Number
Email
Preferred method of contact: (Select one.) Email Phone
About the Business
*Business Name
*Type of Business
DCWP License Number
Business Address
City, State, ZIP Code
Phone Number
Email
Website
Have you been in contact with the business about the complaint? Yes No
If you checked “Yes,” complete rows below.
Name and Contact Information of Employee
What happened?
What was the outcome?
About the Complaint
Reason for Complaint: (Select all that apply.)
Prices not posted/inaccurate
Overcharge
Defective good or service
Advertising is false or misleading
Refused refund/return/exchange
Refused to accept cash payment
Other (explain):
Did you purchase a good or service from the business? Yes No
If you checked “Yes,” complete rows below.
Date of Transaction
Description of Product(s) or Service(s)
Cost of Product(s) or Service(s)
How did you pay? Cash Check Credit card Other (explain):
Was it an internet purchase? Yes No
Did you sign a contract with the business? Yes No Don’t recall
Are there account numbers or other information the business needs to find you in their system?
Yes; Account number(s):
No
Have you filed a case in court related to your complaint? Yes No
If you checked “Yes,” complete rows below.
Case Number
Court
If case is completed, what was the outcome?
*Briefly describe your complaint and the outcome you would like to see. Use additional pages as needed.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
ACKNOWLEDGMENT
By checking the box, I certify that I am the individual who submitted this complaint, and I authorize the business
and/or its agents to discuss my complaint with DCWP. I have read the information on this form and it is true to the
best of my knowledge.
Updated 04/2024