Office of Minnesota Attorney General Keith Ellison

Consumer Assistance Request Form

The Consumer Assistance Request Form is used if you need help with a consumer problem such as unsatisfactory service, bill disputes, or other concerns and would like the Attorney General’s Office to contact the organization on your behalf.

Step One: Fill out the Form

Please fill out the Consumer Assistance Request Form carefully and provide as much information as you can. You may use your computer keyboard to type your information online into each of the boxes. Use the tab key to navigate from box to box. After you have typed your information into each box, you may print the completed form and mail it to our office. (If you prefer, you may print a blank form using this link and write by hand your information onto both sides of the form.)

Step Two: Print and Sign the Completed Form

After you have typed your information online into the boxes, use the Print this Form button at the bottom of the page to print two copies, keeping one for your records. After you print the completed form, be sure to sign it. All complaints require a written signature.

Step Three: Mail the Form to Us with any Attachments.

Attach copies of any relevant documents, such as bills, contracts, canceled checks, correspondence, or advertisements. Please do not send us your original documents. Mail the completed and signed Consumer Assistance Request Form to our Office at the following address:

Office of Minnesota Attorney General Keith Ellison
445 Minnesota Street, Suite 1400
St. Paul, MN 55101

Step Four: Our Response.

We will respond to you as quickly as possible after we receive your information. In some cases, we may assist you in locating other government agencies that can best address the problem.

consumer assistance request form header
Your Information Your Information

Your Name:

Your Street Address:

Your City, State, Zip:

Your Day Phone:

( ) -

Your Night Phone:

( ) -

Your Cell Phone:

( ) -
Company Complained About Company Complained About

Name of Company Complained About:

Its Street Address:

Its City, State, Zip:

Its Phone Number:

( ) -

Its Contact Person:

Their Title:

Have You Contacted Another Agency? Have You Contacted Another Agency

Have you contacted another agency? Yes      No

If yes, give name of agency and result:

Have you filed a lawsuit? Have You Filed A Lawsuit

Have you filed a lawsuit? Yes      No

If yes, what was the result?

Product or Payment Involved (If Any) Product Involved if any

Product/Service Involved:

Date of Purchase:

Amount of Purchase:

Explanation of Problem
Explanation of Problem

More room is available on the next page arrow

Questions Continue on the Next Page arrow

explanation of problem continued 
  • (If you need even more space, please feel free to attach a separate document with more information.)

What do you want the company to do? What do you want the company to do

(If you need more space, please feel free to attach a separate document with more information.)

The information you provide may be used in our efforts to resolve the problem, to communicate with you, and/or to enforce applicable laws. The information may be shared with the party complained against, law enforcement agencies and consumer assistance agencies. You are not legally required to provide this information, but failure to do so may hinder efforts to resolve your problem.

The information I have given you is true and accurate to the best of my knowledge and may be used as stated on this form.

Please mail completed, signed form (and any attachments) to: Office of Minnesota Attorney General Keith Ellison, 445 Minnesota Street, Suite 1400, St. Paul, MN 55101. Call our office at (651) 296-3353 (Twin Cities Calling Area) or (800) 657-3787 (Outside the Twin Cities) with any questions.

Thank you for the opportunity to assist you.

Keith Ellison

Minnesota Attorney General

If you run into any difficulty printing the above form, please fill out this version. We apologize for any inconvenience.