Sample

Your name
Address
City, State, Zip Code

Date


Mr. (or Ms.) _______________________________ (if you have a contact name)
Company name
Address
City, State, Zip Code


Dear Mr. (or Ms.) ___________________________:

I want to inform you of my dissatisfaction with (name of the product with the serial number, or the service performed). I purchased this item (or service) on (date of purchase) at (location of purchase).

My complaint concerns (the reasons for your complaint). To solve the problem, I would like (state the specific action you desire for satisfaction).

I look forward to your reply and resolution of my complaint and will allow two weeks before referring it to the appropriate consumer agency. If you need to call me, my daytime telephone number is (area code and telephone number).

Thank you for your assistance and cooperation in this matter.

Sincerely,

Your name

Enclosures (Include copies of all related records do not send originals.)