US FEDERAL TRADE COMMISSION

How Can the FTC Reach You?

— Fill Out This Complaint —
Supply as much information as you can...

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Items marked with a red astrisk ' * ' are required.

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* First Name:
* Last Name:

Age Range: Select 20 - 29 30 - 39 40 - 49 50 - 59 60 - 64 65 - 69 70 - 79 80 and Over "Click" Arrow for Choices

* Street Address:

*City:

* State: Select Alabama Alaska Alberta, Canada Arizona Arkansas British Columbia, Canada California Colorado Connecticut Delaware District of Columbia Florida Foreign Country Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Location Not Reported Louisiana Maine Manitoba, Canada Maryland Massachusetts Michigan Minnesota Minor Outlying Islands Mississippi Missouri Montana Nebraska Nevada New Brunswick, Canada New Hampshire New Jersey New Mexico New York Newfoundland, Canada North Carolina North Dakota Northwest Territories, Canada Nova Scotia, Canada Nunavut, Canada Ohio Oklahoma Ontario, Canada Oregon Pennsylvania Prince Edward Island, Canada Puerto Rico Quebec, Canada Rhode Island Saskatchewan, Canada South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon, Canada "Click" Arrow for Choices

Country: Select CANADA CUBA Hati MEXICO Not Available PHILIPPINES UNITED STATES UNKNOWN LOCATION "Click" Arrow for More Choices

Zip:

* E-Mail Address:

* Phone:
Home- Area Code ( ) Phone Number (xxx-xxxx)
and/or
Work- (Numbers Only)
Area Code ( ) Phone Number Ext. (Extension)

 

Subject of Your Complaint:
Direct Marketing-Telemarketing/Mail Order
(Includes Campgrounds and Timeshares

* Name of Company You Are Complaining About:

Check If Company Name Is Unknown:

Street Address:

City:

State or Canadian Province:
Select Alabama Alaska Alberta, Canada Arizona Arkansas British Columbia, Canada California Colorado Connecticut Delaware District of Columbia Florida Foreign Country Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Location Not Reported Louisiana Maine Manitoba, Canada Maryland Massachusetts Michigan Minnesota Minor Outlying Islands Mississippi Missouri Montana Nebraska Nevada New Brunswick, Canada New Hampshire New Jersey New Mexico New York Newfoundland, Canada North Carolina North Dakota Northwest Territories, Canada Nova Scotia, Canada Nunavut, Canada Ohio Oklahoma Ontario, Canada Oregon Pennsylvania Prince Edward Island, Canada Puerto Rico Quebec, Canada Rhode Island Saskatchewan, Canada South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon, Canada "Click" Arrow for Choices

Country: UNITED STATES CANADA CUBA PHILIPPINES PUERTO RICO "Click" Arrow for More Choices

Zip Code:

Company Web Site:

Company E-Mail Address:

* Company Phone Number:
Area Code ( ) Phone Number Ext.
(xxx) xxx-xxxx (Extension)

How Did the Company Initially Contact You?
Select Mail Phone E-mail In Person Internet (Other) Internet Web Site Print TV/Radio Unknown "Click" Arrow for Choices

How Much Did the Company Ask You to Pay?
(Numbers Only)

How Much Did You Actually Pay the Company?
(Numbers Only)

How Did You Pay the Company?
Select Cash Personal Check Automatic Withdrawal from my Checking Account Bank Account Debit Electronic Transfer MasterCard Credit Card American Express Credit Card Visa Credit Card Discover Credit Card Other Credit Card Bank Money Order Other Type of Money Order Postal Money Order Cash Advance Cashier's Check Certified Cheque Not Reported Payroll Allotment Unknown
"Click" the Arrow for Choices

Did You File a Dispute with the Credit Bureau?
Select Yes No "Click" Arrow for Choices

Did You File a Dispute with the Credit Bureau More Than 45 Days Ago?
Select Yes No Do Not Know "Click" Arrow for Choices

REPRESENTATIVE OR SALESPERSON:
First Name:

Last Name:

Date Company Contacted You: (MM/DD/YYYY)

* Explain Your Problem: (Llimit your complaint to 2000 characters.):
         (Concerning a campground membership or timeshare scheme )

Did they say you had to pay 'dues' the rest of your your life       or get someone else to do it? Did they say you had to get a new 'ID' then high pressure you into an 'upgrade'? Do they demand money from you even after you told them, in writing,       that you do not want to be a member? HOW WERE YOU MISLED, HIGH PRESSURED OR DECEIVED?

*

Then