BERKSHIRE CONSUMER SERVICES PROGRAM
WORKING IN COOPERATION WITH THE MA ATTORNEY GENERAL’S OFFICE
Administered by Berkshire County Regional Housing Authority
1 Fenn Street - 4thFloor Pittsfield, MA 01201
Tel: 413-344-4861 Fax: 413-443-8137
The Berkshire Consumer Program is one of the many Local Consumer Programs throughout the Commonwealth funded by and working in cooperation with the Office of the Massachusetts Attorney General. It provides consumers with information, education, referrals, and a free and voluntary informal mediation process to attempt to resolve complaints between consumers and businesses through letters and telephone calls... If we are unable to resolve your complaint, we will discuss other options you may wish to pursue such as filing a Small Claims action, Face-to-Face mediation, or hiring a private attorney to provide legal representation.
Enclosed you will find the Complaint Form. In order to process your complaint properly and to provide assistance to you, we need your cooperation in filling out the Complaint Form as thoroughly and accurately as possible.
INFORMATION WE NEED FROM YOU:
- Please include your complete address and telephone number where you can be reached between 9 am and 4 pm.
- Provide the complete and accurate name, address, and telephone number(s) of the company and/or company individual(s) with whom you are having a dispute.
- Please be sure that your complaint is either typed or written/printed in a legible manner.
- Be sure to attach COPIES of any contract, work orders, repair invoices, bills, receipts, advertisements, or any other documentation relevant to evaluating your complaint. PLEASE SEND COPIES, NOT ORIGINALS. Documents cannot be returned.
COMPLAINT PROCESS
When we receive your completed Complaint Form, it will be reviewed, and if appropriate for this office, we will contact you, explain the process, and then attempt to mediate your dispute. Please note: It may take several days to review your complaint. We request and appreciate your patience during this time. If your complaint is appropriate for mediation, the mediator will contact both you first and then the business with which you are having the dispute and attempt to mediate a resolution. There is no fee for any of our services, and if the matter is not resolved through this free and voluntary mediation, you have not lost any rights you may have to pursue legal action on your own.
OTHER ASSISTANCE
If you have questions concerning specific application or interpretation of the law, you should consult a private attorney. Our office cannot provide legal advice or representationthrough this Local Consumer Program.
MA Lawyer Referral Service: 800-392-6164
Community Legal Aid for those who qualify: 800-639-1509
Berkshire Bar Association: 413-442-5999
This page is an Instruction Page only and does not need to be submitted as part of the two page Complaint Form that follows.
BERKSHIRE CONSUMER SERVICES PROGRAM
Local Consumer Program Complaint Form
Our Local Consumer Program works in cooperation with the Massachusetts Attorney General’s Office.
If your complaint is urgent or if you seek an accommodation due to a disability, pleasecall the AGO Consumer
Hotline at 617-727-8400 or 617-727-4765 TTY or the Elder Hotline at 888-243-5337. The AGO Consumer
Hotline can answer questions, provide information, and offer referrals.
Your Contact Information:
First Name: ______Last Name: ______
Address: ______
City: ______State: ______Zip Code: ______
Daytime Phone: ______(+ ext. if applicable)
You will only be contacted during normal business hours at the number you provide
Email address: ______
Optional Information: Check here if you are: Over 60 Veteran of U.S service. or on Active Duty
You are not required to provide this information to file a complaint, but having it may help us serve you more effectively.
Are you filing this Complaint as an Individual? YES NO
The Local Consumer Program cannot accept a complaint or mediate a dispute filed by a business against an individual or another business.
Information on the Business or Organization that is the subject of the Complaint:
Name of the Business you are filing this Complaint against: ______
Address: ______
City: ______State: ______Zip Code: ______
Phone: ______Type of Business (Please be specific): ______
Was this an online transaction: YES NO
Description of Your Complaint/Dispute: PLEASE TYPE or PRINT if your handwriting is difficult to read. Include relevant names and contact information, and describe any action you have taken to resolve the dispute yourself and how the business has responded. If you prefer, you may type the information on a separate sheet and attach to the Complaint. If you do, simply write below: “See Attached”
______
______
______
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If you made a payment, please indicate method (optional): Cash Check Credit Card Prepaid Card Money/Wire Transfer Other
What outcome do you seek from filing this Complaint?
Assistance from the program and possible mediation of my complaint.
I only want to let the Program and the Attorney General’s Office know about this business or trade practice.
If you are requesting mediation, what resolution do you seek?______
If you are seeking a dollar amount as part of a resolution, please indicate amount: $______
Have you complained directly to the business? YES NO
Have you previously contacted the Attorney General’s Office or any other agencies about this problem? YES NO
If yes, please list dates and names of agencies you have contacted: ______
______
Have you retained an Attorney to represent you in this matter: YES NO
Has the subject matter of this Complaint been taken to court? YES NO
Please review your Complaint form after completing ALL sections and questions and reviewing the Instruction Page carefully. Please retain a copy for your records and mail or email photocopies of any documentation you think may be helpful in mediating your complaint. Please do not include financial account numbers, credit/debit card numbers, your social security number, or other sensitive personal information. We will contact you if we need any of this information.
Important: Read the following before signing and submitting your complaint:
- Disclosure of Your Complaint.You understand that, under most circumstances, your complaint will be considered a public record and be available to any member of the public upon request.
- Disclosure to the Business.You understand this complaint may be sent to the business you have filed the complaint about, and you authorize that business to release any and all information with regard to this complaint to the Berkshire Consumer Services Programworking in cooperation with the Office of the Massachusetts Attorney General.
- Disclosure to Other Entities. You understand that your record in its entirety may be disclosed to law enforcement and/or regulatory agencies who may assist in resolving your complaint.You also understand that the Berkshire Consumer Program may forward this complaint to another agency if necessary to resolve your complaint.
- Consulting with Legal Counsel. You understand that neither the AGO nor the Berkshire Consumer Services Program may give you legal advice or act as your personal lawyer or advocate.
- Responsibility to provide documentation or assistance where necessary. You understand that as the
consumer filing a complaint in this matter, it is your responsibility to participate fully and promptly in the mediation by providing any documentation or information supporting your claim that is requested by the Program.
SIGNATURE: ______DATE:______
By signing my name above, I acknowledge that I have read and understood the provisions above and certify that the information I have provided is true and correct to the best of my knowledge.