Delaware County Consumer Affairs Questionnaire

Delaware County Consumer Affairs Questionnaire
Please fill out this form for consumer affairs issues that occur WITHIN Delaware County, PA. Provide as many details to your concern or issue as you can. Do NOT provide any personally-identifying information outside of how to best contact you for a follow-up.

Please allow 2-3 business days (excluding holidays/weekends) for a representative to follow up with you regarding your issue. For further assistance, please email DelcoCA@co.deleware.pa.us with your question.

Fields with an asterisk (*) are required in order to file a complaint.
Please check if you or the family member you're filing on behalf of, is a senior, member of the military, or a veteran. If not, please select "None."
Filer Fullname

First NameLast Name
Email Address
example@example.com

Address
Street Address (ex: 201 W. Front St)
Address 2
Street Address Line 2 (ex: Apt 405)
Municipality
(ex: Media)
Zip Code
(ex: 19063)
Phone Number

Area CodePhone Number
Complaint Information

Please explain your complaint. Be sure to tell what happened, when it happened, and where it happened. Be specific about any and all interactions with the entity you're filing a complaint against. Especially include anything that impacted your decision to purchase/procure/enter into a contract with the entity. Please describe events in the order in which they occurred.
Date of Issue (or when the issue began)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Business or Entity Name
(ex: Wolves of Wall Street LLC., Landlord Name, etc..)
Business or Entity Email
(ex: businessname@email.com)
Business or Entity Phone Number

Area CodePhone Number
Contact Person at Business/Entity
Address or Location of Issue
Street Address (ex: 201 W. Front St)
Address 2
Street Address Line 2 (ex: Apt 405)
Municipality
(ex: Media)
State / Province
Zip Code
(ex: 19063)
What is the nature of your concern?
Please describe your issue or request in detail
Provide date of incident, location, and your relation to the incident. The more detail the better.
How would you like to be contacted for follow-up?
Should be Empty: