[Your name]
[Street Address]
[City ,St Zip]
[Optional – Email address]
[Today’s Date]
[Name of Recipient]
[Title]
[Company]
[Address]
[City ,St Zip]
Dear(Name of Recipient]
heading with relevant reference numbers
[Short introduction paragraph – Provide details about the product or service that is the subject
of the complaint. Include dates, location and specifics about the item or service. If there is an
account number, provide the number ]
[State the issue with item or service. Provide details as to the cause. This may include billing
issues, details that was not disclosed, etc.]
[Indicate how you would like them to resolve the problem. Provide specifics about what you
are seeking. This may include reimbursement, replacement, repair, etc.]
[Indicate you are including copies of the transaction documents. State the specific documents
or information you are including. This may be copies of receipts, serial numbers, etc.]
[Indicate you look forward to their reply within a specific time period(choose a
reasonable time period). Indicate you will wait them before pursuing other options such
as legal counsel or consumer protection agency assistance.]
[indicate they can contact you about the issue and provide a contact number.]
Sincerely/Faithfully,
Your signature
Your printed name