Organization Title 


  1. Complaint
  2. Upload related documents (Optional)
  3. Notice Under State Law
Tell Us About Yourself
Have you contacted the financial institution, business, firm or individual(s) regarding your complaint? If Yes, include name, dates and results of your contact(s) in Complaint Description below. Attach copies of all related documents.
Please clearly describe the events in order in which they occurred. Include full names, addresses, a description of the problem with the amount(s), date(s) of any transaction(s) and the contact information of any witnesses, and any other relevant information that may assist us in resolving your complaint. Please state if you have filed a lawsuit or arbitration for this complaint. For your protection, DO NOT INCLUDE PERSONAL CONFIDENTIAL INFORMATION SUCH AS YOUR SOCIAL SECURITY NUMBER
Who Are the Persons/Businesses Involved?
What do you believe would be a fair resolution to this matter?
In submitting this complaint, you agree the information provided is true and correct to the best of your knowledge and that the information may be used by the Department for its investigation. Consumer complaints are considered to have been received by the Department in confidence. However, the Department may, at its sole discretion, disclose your complaint to the person or entity for the purpose of corrective action. The Department may also choose to disclose your complaint to others for the purpose of facilitating an investigation of the person or entity complained against or initiating legal proceedings against the same under the Department's investigation.