NEW YORK ATTORNEY GENERAL RESTITUTION FUND CLAIM FORM
The New York State Attorney General recently entered into settlement agreements with a number of companies that sell consumer electronics, such as digital cameras and camcorders, online. These settlement agreements require the setting aside of funds to provide partial or full refunds to consumers who may have been defrauded by these companies. The Better Business Bureau of Metropolitan New York, Inc. ("NY BBB") has been retained to administer these funds.
If you believe you are entitled to a refund from any one of the "List of Online Consumer Electronic Merchants", please click here for the entire list, fill in the following form completely and mail it to the address below, postmarked no later than December 1, 2009 .
NOTE: All claims post-marked after December 1, 2009 will be denied.
If you have a question, please call 212.358.2857 and leave your name and phone number. We will call you back within a few days.
Name:_________________ _____________________
Last First
Street Address __________________________________________
City _______________ State _________ Zip ___________
Telephone number ____________________
Email address ________________________________________
I purchased:___________________________________________
(name of merchandise)
from:_________________________________________________
(Online consumer electronics company)
On: ___________________, 200 _.
(date)
The cost of the product was $ _____________, and I paid the amount of $__________.
I paid by:
___Credit Card ___ Debit Card:
(Type of credit or debit card):
___Visa ___Mastercard ___AMEX ___Discover ___Other
Submit all proof with this form.
The issue with the merchandise was:
_ Shipping, handling, and/or insurance charges
_ It was damaged, lost and/or stolen
_ It was not the product I originally ordered
_ The price charged was higher than was originally stated
_ Other:________________________________________
(please descrbe)
Submit all proof with this form.
The merchandise was:
_ Returned, partially or in whole
_ Cancelled/attempted to cancel before shipment
_ Stopped payment with credit card company
_Other:___________________________________________
(please describe)
Submit all proof with this form.
I have received the following amount back for this merchandise:
_ From my credit card company $___________
_ From the Online Consumer Electronics Company $ _______
_ From other source $ ________
_ Nothing back from any source
_Other:_____________________________________________
(please describe)
Submit all proof with this form.
Please provide a brief description of your claim here:
__________________________________________________________
__________________________________________________________
__________________________________________________________
I claim that I am entitled to $ ______, the amount I paid less any amount I have already received.
I affirm under penalty of perjury that the information contained in this form or attached hereto is true and accurate to the best of my knowledge and that the documents attached to this form are true and correct copies.
_______________________ ____________
Signature of Consumer Date
_____________________________________
Notary
Please mail this form and all attached documents to:
Online Consumer Electronics Restitution Funds
Better Business Bureau of Metropolitan New York, Inc.
257 Park Avenue South, 4th Floor
New York, New York 10010
Claims must be post-marked on or before December 1, 2009. All claims post-marked after December 1, 2009 will be denied.