Complaint Form

COMPLAINT FORM

NOTICE

In the event an investigation is opened Enforcement procedures require a copy of the complaint and all associated documentation be forwarded to the Respondent including your name and contact information.
If you wish to file your complaint anonymously to ensure your identity is not revealed, you must leave section ‘B’ (You, as the complaining party) blank.
Under the Texas Public Information Act, the complainant’s identity is subject to being revealed.
If the complaining party files anonymously they will not receive automated status updates.

In order for the Texas Department of Licensing and Regulation to pursue an investigation of your Service Contract Provider complaint please provide all documentation and information related to your complaint. If your complaint does not contain enough information for the Department to make a determination that a violation has occurred, your complaint may not be opened for investigation.

When completing section D of this form, important information to support your complaint may include:

complete explanation of your complaint
full name, address and registration number of the service contract provider
the date you purchased your service contract
whether you paid in full for your service contract or are paying for it over time
the dollar amount you have paid to date
the date you requested a refund or cancellation
the amount of refund and date you received it
the date you filed a claim against the service contract
a detailed explanation of the service provider company’s response
names, addresses and telephone number of any witness you mention in your complaint

Documentation to support your complaint may include: (Please do not send original documents. All documents you send us will be scanned, electronically saved, and then destroyed.)

complete copy of your service contract
proof of payments made
a copy of the website from which you purchased the service contract
a copy of any solicitation you received
a copy of your request for a refund or cancellation
a copy of invoices or estimates for repairs
a copy of any claims filed
denial letter
any correspondence between you and the service contract provider

Please submit additional documentation in support of your complaint to the Department by fax (512)539-5698 or mail to TDLR, Enforcement Division, P.O. Box 12157, Austin, Texas 78711. Please do not send original documents. All documents you send us will be scanned, electronically saved, and then destroyed. Submitted documentation can only be received via e-mail, fax or regular mail. Attachments cannot be submitted with this link.

A.	If you answer yes to this question, you are required to supply your name and full address in Section B of this form.
	Would you be willing to testify if this case results in a hearing?	YesNo

Type of Complaint: Service Contract Provider
B.	You, as the complaining party:
	Name:
	Company:
	Address:
	City:	State: Zip:
	Work Phone:	Home Phone: Mobile Phone:
	Fax:	E-mail:

C.	The person or firm you are complaining about:
	Name:
	Company Name:
	Physical Address:
	City:	State: Zip:
	Mailing Address:
	City:	State: Zip:
	Office Phone:	Fax: Mobile Phone:
	E-mail:	License or Registration #:

EXPLANATION: Describe your complaint in detail. Please note that if you exceed 5000 characters, your complaint will not be submitted in its entirety. You have characters left.

Please hit the Submit button to get a Verification Page and continue the complaint process.

Click BACK to go to Previous Page