Price Gouging Complaint Form

OFFICE OF THE ATTORNEY GENERAL OF VIRGINIA

CONSUMER PROTECTION SECTION

202 North Ninth St., Richmond, VA

23219

Consumer Protection Hotline (800) 552-9963 or (804) 786-2042 • Fax: (804) 225-4378 • www.ag.virginia.gov

PRICE GO

UGING COMPLAINT

FORM

(Revised 08/12)

The Virginia Post-Disaster Anti-Price Gouging Act

• The Anti-Price Gouging Act prohibits a “supplier” from charging unconscionable prices for “necessary goods and

ser

vices” within the affected area during the thirty (30) day period following a declared state of emergency.

• The term “necessary goods and services” includes those goods or services for which demand does, or is likely to,

increase as a result of the disaster. Potential examples include, but are not limited to, water, ice, food, generators,

bat

teries, home repair materials and services, and tree removal services.

• The basic test for determining if a price is unconscionable is whether the post-disaster price charged by a “supplier”

for a “necessary good or service” grossly exceeds the price charged for the same or similar goods or services either

by the same sup

plier, or within the same trade area, during the ten (10) days

immediately

prior to the disaster.

• Violations of the Anti-Price Gouging Act are enforceable through the Virginia Consumer Protection Act. However,

enforcement and legal actions can only be brought by an authorized government agency. Individuals cannot sue

other individuals or businesses under the Anti-Price Gouging Act.

Where to File Price Gouging Complaints

• Complaints relating to sales of “necessary goods and services” other than gasoline, diesel, and other motor fuels

should be filed with the Office of the

Attorney

General of Virginia using this form.

• Complaints relating to sales of gasoline, diesel, and other motor fuels should be filed with the Virginia Department of

Agr

iculture and Consumer Services, Office of

eights and Measures. You may contact the Office of Weights and

Measures at (804) 786-2476, or visit

www.vdacs.virginia.gov

to obtain the Motor Fuels Price Gouging Complaint Form.

• Fairfax County has its own locally operated office of consumer affairs. If your complaint resulted from a transaction

in that locality and does not involve the sale of gasoline, diesel, or other motor fuels, please contact its consumer

affairs office directly:

Fairfax C

ounty Department of Cable and Consumer Services

Consumer Affairs Branch

12000

Government

Center Parkway, Suite 433, Fairfax, VA 22035

Phone: (703) 222-8435

Website: https://www.fairfaxcounty.gov/consumercomplaint/

Important Information

• Please make sure to include COPIES of supporting documents such as contracts, invoices, receipts, etc. Do NOT

include originals. If you have available, please include copies of photographs to substantiate any claims relating to

home repair and/or tree removal services.

•

e do NOT need your Social Security Number or any other personal financial information not specifically related to

your complaint

. Please mark out/delete this

information

from any documents that you wish to attach to this form.

• For additional information, please call the Consumer Protection Hotline at (800) 552-9963 or (804) 786-2042 if calling

from the Richmond area or from outside Virginia. Our business hours are 8:30 a.m. to 5:00 p.m., Monday through

riday.

Notice of Confidentiality

Pursuant to Section 59.1-528, Code of Virginia, this complaint form and all related attachments, notes and information are

exempt from public disclosure and shall remain confidential. However, such evidence may be used in an action to

enforce the Virginia

Post-Disaster

Anti-Price Gouging Act.

OFFICE OF THE ATTORNEY GENERAL OF VIRGINIA

CONSUMER PROTECTION SECTION

202 North Ninth St., Richmond, VA

23219

Consumer Protection Hotline (800) 552-9963 or (804) 786-2042 • Fax: (804) 225-4378 • www.ag.virginia.gov

(804) 225-4378 • www.ag.virginia.gov

(Revised 08/12)

For official use only. Complaint Numbe

SECTION 1 - Your Information

PRICE GOUGING COMPLAINT FORM

Mr. Mrs.

Ms.

Last name

First name

Mid. Initial

Mailing address

Apt. or suite number

City

State

Zip Code

Tel. number, including area code

( )

Work number, including area

code

( )

Fax number, including area code

( )

City or county of residence

Your e-mail address

If necessary, should we contact you at home, work or by e-mail?

If necessary, best time to reach you during the

day?

SECTION 2 – Name of Company or Individual about Which or Whom You Are Complaining

Full name of company or individual

Name of person(s) with whom you dealt

Mailing address

Office or suite number

City

State

Zip Code

Tel. number, including area code

( )

Company’s Internet address (URL)

SECTION 3 - Complaint Information

Type of product, item, or service involved

Date of purchase, service, contract, etc

Manufacturer or brand

Model

Serial number

Did you sign a contract or a lease?

Yes [ ] or No [ ]

If yes, please indicate the following:

Starting date: Expiration date:

Total amount paid

How was payment made? (Cash, credit card, check, money order, etc.)

To your knowledge, did the amount you paid exceed the price charged or advertised by the same company or individual, or the price charged or

advertised by other companies in the same trade area, for a similar product or service ten (10) days prior to the disaster? Yes [ ] or No [ ]

If yes, please indicate the following:

What was the price charged or advertised ten (10) days before the disaster?

When and where did you see the pre-disaster price charged or advertised?

What was the price charged or advertised after the disaster?

When and where did you see the post-disaster price charged or advertised?

-Continued on next

SECTION 4 – FULL DESCRIPTION OF COMPLAINT – USE ADDITIONAL SHEETS IF NECESSARY

SECTION 5 - Resolution Attempts You Have Made

Have you contacted the company or individual? Yes [ ] or No [ ]

If yes, name of person most recently

contacted

Their phone number, incl.

area code

( )

Results

What resolution would you consider mutually fair?

List any other organizations you have contacted (e.g. Other consumer protection offices, Better Business Bureau, etc)

SECTION 6 – Disclaimers and Affidavits

• By signing this form, you authorize the Office of the Attorney General of Virginia and any other local, state or federal agencies with

which we may work on this matter, to evaluate your complaint, to contact you and to take whatever lawful actions are deemed

appropriate with regard to your complaint.

• By signing this form, you certify that the statements made herein or on any attached documentation are true and complete to the best

of your knowledge, information and belief.

Signa

Date

Mail to Office of the Attorney General of Virginia, Consumer Protection Section, 202 North Ninth Street,

Richmond, VA 23219, or fax to (804) 225-4378.