INFORMAL COMPLAINT TO BE FILED UNDER 

THE PERISHABLE AGRICULTURAL COMMODITIES ACT

Complaining Party: Date:_____________________________________________________ 

Company Name:______________________________________________ Contact Person:_____________________________________________ 

 ______________________________________________ Phone No:_________________________________________________ 

 

Address: 

 ______________________________________________ Fax No:___________________________________________________ 

PACA License No.: ___________________________________________ Email: ____________________________________________________ 

Complaint To Be Filed Against: 

Company Name:______________________________________________ Contact Person:_____________________________________________ 

Address: ______________________________________________ Phone No:_________________________________________________ 

 ______________________________________________ Fax No:___________________________________________________ 

PACA License No.: ___________________________________________ Email: ___________________________________________________ 

If there is a dispute, or the complaint does not involve unpaid invoices, please state your claim below. You may also 

attach a separate letter describing the dispute. Please be sure to include copies all relevant documents, such as invoices, 

passings, bills of ladings, and inspections. If a broker was involved, please provide name and address of the broker, along 

with copies of the confirmations of sale, and/or any other documents issued by the broker. 

Please Provide Your Written Explanation Below: 

Please use the table below to list the unpaid invoices. If you require more space you may use a separate sheet of paper to 

list the invoices and amounts due. 

Invoice No. Date Shipped Invoice Amount Amount Paid Balance Due

Total Claim Amount: 

Documents and items required with this complaint:

• $100 Filing Fee. Please make checks payable to “USDA-AMS”

• Include copies of supporting transaction documents such as: Invoices, Revised Invoices, Passings, Account

Statements, Credit Memorandums, Payment Term Agreements, Contracts, Bills of Lading, Confirmations of Sale,

and Inspection Certificates

Please Note; Complaints received without the Filing Fee cannot be processed.
INFORMAL COMPLAINT TO BE FILED UNDER

THE PERISHABLE AGRICULTURAL COMMODITIES ACT

If you prefer, you may pay the filing fee with a credit card. If so, please provide the following information: 

Check Type of Credit Card: ___Visa ___ MasterCard ___ American Express ___ Discover 

Indicate Credit Card Charge Amount: ____ Informal, $100 ____ Formal, $500 _____ Other, $_______________ 

Card No:____________________________________________________ Expiration Date:_________________________________________________ 

Card Holder Name:_______________________________________________ Card Holder Signature:___________________________________________ 

(Please Print as Shown on Card) 

Daytime Phone No:_______________________________________________ Contact Name:__________________________________________________ 

USDA PACA Field Offices:

www.ams.usda.gov/paca

U.S. Department of Agriculture 

AMS, F&V Programs, PACA Branch 

819 Taylor Street 

Suite 8B02 

Fort Worth, Texas 76102-9727 

Telephone: 800-495-7222 (toll free) Ext. #4

Fax: 817- 978-0786

Email: PACAcentral@ams.usda.gov 

States Served: AL, AR, FL, IL, IN, KY, LA, 

MI, MS, OK, TN, TX, WI 

U.S. Department of Agriculture 

AMS, F&V Programs, PACA Branch 

Tucson Federal Building, Room 7 T 

300 West Congress Street 

Tucson, AZ 85701-1319 

Telephone: 800-495-7222 (toll free) Ext. #5

Fax: 520-670-4798 

Email: PACAwest@ams.usda.gov

States Served: AZ, CA, CO, ID, IA, KS, MN, MO, 

MT, ND, NM, NE, NV OR, SD, UT, WA, WY, AK, HI 

U.S. Department of Agriculture 

AMS, F&V Programs, PACA Branch

100 Riverside Parkway, Suite 101

Fredericksburg, VA 22406 

Telephone: 800-495-7222 (toll free) Ext. #3 

Fax: 540-373-2690

Email: PACAeast@ams.usda.gov

States Served: CT, DC DE, GA, ME, MD, MA NC, 

NH, NJ, NY, OH, PA, RI, PR, SC, VA, VI, VT, WV, Guam 

Security Code from Back of Credit Card: ______________________