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Financial Institutions Complaint Form

Important Notice: Disclosure of this information is voluntary. However, failure to supply complete information may result in this complaint not being processed.

Is your complaint against an institution we regulate? The Division does not regulate banks, credit card companies or credit unions that have "Federal" in its name.

It is important to remember that the Division does not act as the complainant's attorney. It also does not have the power to adjudicate complaints. If a dispute turns on facts that do not involve a supervised entity's violation of a specific law or regulation (such as a matter concerning a financial institution’s exercise of internal policies or guidelines) the Division may not have the authority to obtain the relief a complainant is seeking. In that case, the Division will advise the complainant about other ways to pursue the complaint, such as through consulting a private attorney and/or initiating a court proceeding.

1. Who is the complaint against?

Complaint Division:

CompDivision

Name of Company:

Company Address 1:

Company Address 2:

City:

State:

Zip:

Telephone:

Please select Company Type:

Date of Incident

2. How do we contact you?

First Name:

Last Name:

Mailing Address 1:

Mailing Address 2:

City:

State:

Zip:

Day Phone:

Evening Phone:

Your E-mail Address:

Account Number:

3. Briefly describe your complaint:

Please list the specifics of your complaint including dates of contact(s), individuals that assisted you and the actions you have taken to resolve this complaint. If more information is needed, you will be contacted by e-mail or telephone.

(NOTE: Limit 3,000 characters)

If you are unable to transmit this complaint, please complete one of our complaint forms located below and mail them to the address located on the form.

Fill In and Print Complaint Form for Currency Exchange and Title Insurance

Fill In and Print Complaint Form for Consumer Credit and Credit Union